The Province of Ontario has a program for residents 65 and older called the Ontario Drug Benefit (ODB) program. Below are some frequently asked questions to help you understand what this drug program means to you. 

What is the Ontario Drug Benefit program? 

The ODB program covers the majority of the cost for more than 4,300 prescription drug products for Ontario residents from August to July of each year.1 The program can also help you pay for allergy shots and an EpiPen®, some diabetes monitoring and testing products, some prescribed over-the-counter drugs and some nutrition products. 

The coverage year for the ODB is August to July.  

How do I qualify? 

In order to be eligible for the program you must be a resident of Ontario, and must be able to provide a valid (i.e. not expired) health card to your pharmacist. The prescription must also be filled at an Ontario pharmacy. 

How do I find out which products are covered by the ODB program? 

To find out which products are covered by the ODB program, you can search the Ontario Ministry of Health and Long Term Care Formulary online.2 However, the Ministry recommends verifying which products are covered under the ODB program with your pharmacist, doctor or nurse practitioner because some of the information is technical. 

The Ontario Drug Benefit program covers a lot of the same medications my RTIP plan covers. What do I do? 

Since the ODB program may cover most of your prescription costs once you turn 65, RTIP offers its members the flexibility to decrease their coverage and change plans. This flexibility protects you from getting stuck paying for more prescription drug coverage than you need. 

Call your pharmacist to determine the annual cost of your prescription drugs that are not covered under the ODB program. Use that number to find the coverage that is right for you. At your next renewal you can opt to decrease your prescription drug coverage, therefore reducing your monthly premiums.  

Do I have to pay a deductible? 

Your deductible depends on how you qualify for the Ontario Drug Benefit. These categories include: 

• Seniors 
• Living in a long-term care home or home for special care 
• Enrolled in Ontario Works, Ontario Disability Support Program or Home Care 
• Enrolled in the Trillium Drug Program 

What do I have to pay as an RTIP member? 

For all RTIP members aged 65 and older, the deductible you pay at the start of the ODB benefit year (August to July) is $100. For example: when filling a prescription at the pharmacy in August at the start of the ODB coverage year, the RTIP member is required to pay: 

• The one-time $100 deductible at the start of each benefit year (August to July). 
• Up to $6.11 for each drug prescribed, filled or refilled until the $100 yearly limit set by ODB is reached. This amount is called the co-payment. 

Once you reach your $100 limit, you will have to pay out of pocket for prescriptions as your RTIP Plan does not cover ODB drugs. All drugs not covered under ODB can be reimbursed through your RTIP plan.  

Here’s the good news! The one-time $100 deductible is eligible for reimbursement from your RTIP plan (not including the dispensing fee). After the deductible is reimbursed by your RTIP plan, the ODB program will cover any portion of your drug claim covered by the provincial health plan. 

To learn more about the Ontario Drug Benefit Program and deductibles, please visit Ontario.ca 

Need support for high prescription-drug costs? Learn more about what drugs are covered under the Trillium Drug Program.  
 

Sources 

1. Government of Ontario 

2. Ontario Drug Benefit Formulary