Guide to Drug Coverage in Ontario

All Canadians have access to the insured health services defined by the Canada Health Act including all medically necessary hospital services, inpatient pharmaceuticals (medicines used while you are hospitalized), and medically required physician services. Prescription medicines used by individuals who are not hospitalized (outpatients) are not paid for by this system. 

Note: Any resident of Ontario with valid OHIP is eligible to apply for the Trillium Drug Program if their private insurance does not cover 100% of their prescription drug costs and they are not eligible for drug coverage under the Ontario Drug Benefit Program.

The following questions will help you identify any prescription drug benefits you may be eligible for:

  • Ontario Drug Benefit Program

    For information about who is eligible, where to obtain medications and costs/deductibles click here

    For an ODB Application Form click here.

  • Ontario Drug Benefit: Trillium Drug Program

    The Trillium Drug Program is available to all residents of Ontario with valid Ontario Health Insurance (OHIP) regardless of their income level. Individuals or families can apply to the Trillium Drug Program if private insurance does not cover 100% of their prescription drug costs and if they are not eligible for drug coverage under the ODB Program. The program has a deductible that is based on income and family size. 

    For a complete guide to the Trillium Drug Program including a table that lets you find out your deductible, click here.

  • Trillium Drug Program Applications

    Applications are available at Ontario pharmacies or by calling the Ministry INFOline at (416) 314-5518, 1-800-268-1154 (toll-free in Ontario only). Click here to view the application. 

    Trillium Drug Program Information line (416) 326-1558, 1-800-575-5386

    For additional Trillium Drug Program information, click here.

  • What prescription medications do the Ontario Drug Benefit Program and the Trillium Drug Program cover?

    Medications listed in the Drug Benefit Formulary/Comparative Drug Index (ODBF/CDI) are covered. Additionally, prescribers may apply for coverage of a drug that is not listed in the ODBF/CDI through the Exceptional Access Program.

  • Ontario Drug Benefit Formulary/Comparative Drug Index (ODBF/CDI)

    For a complete guide to the Ontario Drug Benefit Formulary/Comparative Drug Index (ODBF/CDI) which includes an explanation of the Formulary, listing of Drug Products, Facilitated Access Drug Products, Trillium Drug Program, Individual Clinical Review, nutritional products and Limited Use products click here.

  • Ontario Drug Benefit and Trillium Drug Program / Exceptional Access Program (for coverage of a non-listed drug product)

    Persons covered under the Ontario Drug Benefit Program (including clients of the Trillium Drug Program) may be eligible for coverage of a prescription drug that is not listed in the ODB formulary through the Exceptional Access Program. 

    A patient's physician may chose to submit a letter or form requesting coverage for a particular drug product not normally covered under the ODB Program. As part of the request, the physician is required to submit relevant medical information including an indication of why other products covered by the program cannot be used. Medical experts review the request and advise whether coverage has been approved. 

    Important note: The Ministry will consider requests for non-ODB drugs even if a person is not yet eligible for ODB coverage. If a person is in the process of applying for ODB coverage or to the Trillium Drug Program, their physician can submit an an EAP request for a non-ODB drug to the Ministry (they should state that the ODB or Trillium application is in progress). This will save time as the application process and the EAP request process can go on simultaneously. 

    For more information on the Exceptional Access Program, click here.

  • Limited Use Drug Products

    The ODBF/CDI lists some drugs as Limited Use. This means the drug is covered when used according to specific clinical criteria and conditions. For more on Limited Use, click here.

    For the Handbook of Limited Use Drug Products, click here.

  • Ontario Drug Benefit: Special Drugs Program

    Through the Special Drugs Program, the Ministry of Health and Long-Term Care covers the full cost of certain outpatient drugs used in the treatment of specific conditions. Click here to view what the program covers. 

    Ontario patients with valid OHIP with one of the diseases or conditions covered, are eligible for the Special Drugs Program. The Special Drugs Program covers the entire cost of certain outpatient drugs (there are no deductibles or co-payments) for those who meet the established clinical criteria when prescribed by a designated centre/physician for a specific drug product.

  • Ontario Health Insurance Plan (OHIP)

    The Ministry of Health and Long-Term Care pays for a wide range of medically necessary services for Ontario residents with valid OHIP insurance. All Ontario residents who meet the following are eligible for provincially funded health coverage (OHIP: Be a Canadian citizen or have immigration status as set out in Ontario's Health Insurance Act, and make your permanent and principal home in Ontario, and be physically present in Ontario 153 days in any 12-month period). 

    On-line OHIP forms

  • Ontario - Ministry of Health and Long Term Care Home Page