Health Care: Coverage of Drug Costs -- Fast Facts

The Elderly Services Advisory Committee (ESAC) has provided the following information on the Ministry of Health’s major programs that assist with covering the costs of drugs for individuals and families. ESAC is an advisory body to Halton Regional Council that provides information on seniors’ issues so that Council can make informed decisions on behalf of the Halton seniors. ESAC’s mission is to promote the well-being and quality of life for seniors in Halton.

For more information about ESAC call Halton Region at 905.825.6000 or toll free at 1.866.442.5866, ext. 7767 or visit the Halton Region site

1. Ontario Drug Benefit Program (ODB)

Eligibility:

People 65 years and older
Residents of Long Term Care facilities
Residents of homes for special care
People receiving professional services under the Community Care Access Centre of Halton (home care)
Trillium Drug Benefit recipients
Individuals receiving social assistance

What is Covered:

Approximately 3000 prescription drugs
A number of limited-use drugs products
Some nutritional products
Some diabetic testing products

Costs:

Based on income, a senior’s co-payment will be $2 or $6.11
High income seniors will also pay a $100 deductible.

2. Trillium Drug Program

Eligibility:

You have high drug costs in relation to income
Your private insurance does not cover 100% of prescription drugs
Valid Ontario Health Insurance (OHIP)
You are not eligible for coverage under the Ontario Drug Benefit Program

What is Covered:

Over 3100 prescription drugs
Over 300 limited-use drug products
Some nutritional products
Some diabetic testing products

Costs:

There is a deductible based on income and family size
A co-payment of up to $2 may also be applied

3. Individual Clinical Review

Eligibility:

Eligible for Ontario Drug Benefit Program or Trillium Drug Program

What is Covered:

In exceptional circumstances (ie. no other treatment, new approved drugs) the cost of drugs not covered by ODBP may be covered
Your doctor must submit the request and relevant medical information to the Ministry of Health for approval

Costs:

Similar to other programs
Co-payment and deductibles may be applied

4. Special Drugs Program

Eligibility:

Ontario resident with valid OHIP
Meet established clinical criteria: and/or are approved by a designated centre/doctor for a specific drug
Patient with one of the diseases or conditions listed below

What is Covered (Currently):

Many drugs for the treatment of thalassaemia
AZT, ddl, ddC and pentamadine for people who are HIV positive
Erythropoietin (EOP) for people with end stage renal disease
Cyclosporine for people who have had a solid organ or bone marrow transplant
Clozapine for treatment of schizophrenia
Alglucerase for people with Gaucher’s Disease

Costs:

There is no deductible or co-payment.

printer friendly

Email this article