ontario regulation 97/26

made under the

Ontario Drug Benefit Act

Made: March 26, 2026
Filed: April 7, 2026
Published on e-Laws: April 7, 2026
Published in The Ontario Gazette: April 25, 2026

Amending O. Reg. 201/96

(GENERAL)

1. Subsection 1 (1) of Ontario Regulation 201/96 is amended by adding the following definition:

“section 20.2 maximum co-payment” means the maximum co-payment determined in accordance with the rules set out in subsection 20.2 (4); (“quote-part maximale prévue à l’article 20.2”)

2. (1) The definition of “annual net income” in subsection 4 (9) of the Regulation is revoked and the following substituted:

“annual net income” means, subject to subsection (10), the amount indicated on the applicable line of the Notice of Assessment issued under the Income Tax Act (Canada) for the relevant taxation year or, if no Notice of Assessment has been issued, the amount that would appear on that line had the Notice of Assessment been issued, in either case minus,

(a) the amount of income from the Universal Child Care Benefit program of the Government of Canada that was reported or that should have been reported on the applicable line of the relevant Canadian income tax return, and

(b) the amount withdrawn from Canadian Registered Disability Saving Plans that was reported or that should have been reported on the applicable line of the relevant Canadian income tax return; (“revenu annuel net”)

(2) Section 4 of the Regulation is amended by adding the following subsection:

(10) A Canada disability benefit payable under the Canada Disability Benefit Act (Canada) shall not be considered in determining annual net income.

3. Subsection 20.1 (2) of the Regulation is amended by striking out “subsection 20.2 (5)” and substituting “subsection 20.2 (4)”.

4. (1) The definition of “annual net income” in subsection 20.2 (2) of the Regulation is revoked and the following substituted:

“annual net income” means, subject to subsection (2.1), the amount indicated on the applicable line of the Notice of Assessment issued under the Income Tax Act (Canada) for the relevant taxation year or, if no Notice of Assessment has been issued, the amount that would appear on that line had the Notice of Assessment been issued, in either case minus,

(a) the amount of income from the Universal Child Care Benefit program of the Government of Canada that was reported or that should have been reported on the applicable line of the relevant Canadian income tax return, and

(b) the amount withdrawn from Canadian Registered Disability Saving Plans that was reported or that should have been reported on the applicable line of the relevant Canadian income tax return; (“revenu annuel net”)

(2) Section 20.2 of the Regulation is amended by adding the following subsection:

(2.1) A Canada disability benefit payable under the Canada Disability Benefit Act (Canada) shall not be considered in determining annual net income.

(3) Section 20.2 of the Regulation, as amended by subsections (1) and (2), is revoked and the following substituted:

20.2 (1) If a listed drug product is supplied for an eligible person described in subsection (3), the maximum co-payment that the operator of a pharmacy may charge in respect of the supply of the drug product for that eligible person shall be determined in accordance with this section.

(2) In this section,

“allowable drug costs” means the sum of any amount spent on co-payments in respect of listed drug products, and in respect of listed substances, that are supplied for an eligible person in the current fiscal period; (“coûts des médicaments autorisés”)

“deductible amount” means an amount determined in accordance with subsection (5) or (6), as applicable; (“franchise”)

“fiscal period” means the period of July 15, 1996 to March 31, 1997, the period of April 1, 1997 to July 31, 1998 and each succeeding 12-month period that commences on August 1 of each year and ends on July 31 of the following year. (“exercice”)

(3) Subject to section 20.3, this section applies with respect to eligible persons referred to in paragraph 4 of subsection 2 (1) who are not part of any other class of eligible persons under the Act.

(4) The maximum co-payment that may be charged in respect of the supply of a listed drug product for an eligible person under this section during a fiscal period shall be determined in accordance with the following rules:

1. Until the eligible person’s allowable drug costs for the fiscal period reach the deductible amount, the maximum co-payment that may be charged shall be the amount equal to the full amount otherwise payable by the executive officer under section 6 of the Act, or section 17 of this Regulation, as the case may be, in respect of the supply of the drug product less,

i. if the drug product is supplied in a pharmacy operated in a hospital approved as a public hospital under the Public Hospitals Act, $6.00,

ii. in all other cases, the amount, if any, by which the dispensing fee exceeds $6.11.

2. Despite paragraph 1, if charging the maximum co-payment permitted under that paragraph would result in the eligible person’s allowable drug costs for the current fiscal period exceeding the deductible amount, the maximum co-payment that may be charged shall be the difference between the deductible amount and the amount of the eligible person’s allowable drug costs paid so far in the current fiscal period.

3. On or after the day the eligible person’s allowable drug costs for the fiscal period reach or exceed the deductible amount, the maximum co-payment that may be charged for the remainder of the fiscal period shall be,

i. if the drug product is supplied in a pharmacy operated in a hospital under the Public Hospitals Act, $2.83,

ii. if the drug product is supplied by a physician whose office is within 20 kilometres of an accredited pharmacy, $4.28,

iii. if the drug product is supplied by a physician whose office is more than 20 kilometres from an accredited pharmacy, $5.10,

iv. in all other cases, the lesser of $6.11 or the amount the operator of the pharmacy that supplied the drug product sets as its dispensing fee under subsection 6 (1) of the Drug Interchangeability and Dispensing Fee Act.

(5) For the purposes of subsection (4), the deductible amount used to determine the maximum co-payment that may be charged for the supply of a listed drug product for an eligible person during any fiscal period is $100.

(6) Despite subsection (5), if a person becomes eligible under the Act during a fiscal period, the deductible amount used under subsection (4) to determine the maximum co-payment that may be charged during the fiscal period for the supply of a listed drug product for that eligible person is set out in Column 2 of Table 1 to this subsection opposite the period during which the person becomes eligible set out in Column 1 of Table 1.

TABLE 1
Deductible Amounts When Person Becomes Eligible During Fiscal Period

Item	Column 1 Month in which person becomes eligible	Column 2 Deductible Amount
1.	On August 1	$100.00
2.	On or after August 2 but before September 2	91.67
3.	On or after September 2 but before October 2	83.33
4.	On or after October 2 but before November 2	75.00
5.	On or after November 2 but before December 2	66.67
6.	On or after December 2 but before January 2	58.33
7.	On or after January 2 but before February 2	50.00
8.	On or after February 2 but before March 2	41.67
9.	On or after March 2 but before April 2	33.33
10.	On or after April 2 but before May 2	25.00
11.	On or after May 2 but before June 2	16.67
12.	On or after June 2 but before August 1	8.33

 

5. Section 20.3 of the Regulation is revoked and the following substituted:

20.3 (1) In this section,

“fiscal period” has the same meaning as in section 20.2; (“exercice”)

“relevant taxation year” means, with respect to a person, the person’s most recent taxation year, or such other taxation year, as may be determined in accordance with section 20.4. (“année d’imposition pertinente”)

(2) Section 20.2 does not apply and, instead, the maximum co-payment that may be charged in respect of the supply of a listed drug product for an eligible person during a fiscal period is the amount referred to in subsection 20.1 (1) if the eligible person,

(a) applied to the Ministry, in the current fiscal period or in any previous fiscal period, for relief from the section 20.2 maximum co-payment; and

(b) meets the criteria set out in any of the paragraphs of subsection (3).

(3) In order to qualify for relief from the section 20.2 maximum co-payment, the eligible person must meet the criteria in one of the following paragraphs:

1. The eligible person must,

i. not have a spouse, and

ii. at the time of their application, have had an individual annual net income that was equal to or less than the applicable individual annual net income threshold established in section 20.5.

2. The eligible person must,

i. have a spouse,

ii. not meet either of the conditions set out in subparagraph 3 i, and

iii. at the time of their application, have had, along with their spouse, a combined annual net income that was equal to or less than the applicable combined annual net income threshold established in section 20.5.

3. The eligible person must,

i. either,

A. be married but no longer live in a conjugal relationship with their spouse, or

B. have a spouse who is a person mentioned in paragraph 2, 5 or 6 of subsection 2 (1), and

ii. at the time of their application, have had an individual annual net income that was equal to or less than the applicable individual annual net income threshold established in section 20.5.

(4) Despite subsection (2), the eligible person’s relief from the section 20.2 maximum co-payment terminates at the end of the fiscal period to which their application relates if the eligible person meets the criteria set out in subsection (3) at the time of their application, based on income reported in their application, but the Ministry,

(a) is not able to verify that income with the Canada Revenue Agency; and

(b) does not receive a Notice of Assessment issued under the Income Tax Act (Canada) for the eligible person or, if applicable, their spouse.

(5) For greater certainty, the denial of an application under this section or the termination of an eligible person’s relief from the section 20.2 maximum co-payment does not prevent an eligible person from re-applying for that relief in respect of another fiscal period.

(6) If, after an application is made in accordance with this section, the eligible person’s relationship status changes, or their spouse experiences a life change, such that the eligible person would no longer meet the criteria set out in subparagraph 1 i, 2 i or ii or 3 i of subsection (3), as the case may be, that they met at the time of their application, the eligible person must notify the Ministry of the change and, if requested to do so, provide such information as the Ministry may require to assess whether the eligible person currently meets the criteria set out in subsection (3).

(7) An eligible person must provide the notice and information required by subsection (6) in a timely manner as a condition of continuing to maintain their relief from the section 20.2 maximum co-payment.

(8) If the Ministry determines, whether due to a notice provided in accordance with subsection (6) or otherwise, that an eligible person’s relationship status has changed, or that their spouse has experienced a life change, such that the eligible person would no longer meet the criteria set out in subparagraph 1 i, 2 i or ii or 3 i of subsection (3), as the case may be, that they met at the time of their application, the Ministry shall reassess the eligible person’s application as if they had submitted a new application under this section.

20.4 (1) This section sets out the rules for determining individual and combined annual net incomes for the purposes of subsection 20.3 (3).

(2) In this section,

“annual net income” means, subject to subsection (3), the amount indicated on the applicable line of the Notice of Assessment issued under the Income Tax Act (Canada) for the relevant taxation year or, if no Notice of Assessment has been issued, the amount that would appear on that line had the Notice of Assessment been issued, in either case minus,

(a) the amount of income from the Universal Child Care Benefit program of the Government of Canada that was reported or that should have been reported on the applicable line of the relevant Canadian income tax return, and

(b) the amount withdrawn from Canadian Registered Disability Saving Plans that was reported or that should have been reported on the applicable line of the relevant Canadian income tax return; (“revenu annuel net”)

“fiscal period” and “relevant taxation year” have the same meaning as in section 20.3. (“exercice”, “année d’imposition pertinente”)

(3) A Canada disability benefit payable under the Canada Disability Benefit Act (Canada) shall not be considered in determining annual net income.

(4) The individual annual net income for an eligible person referred to in paragraph 1 or 3 of subsection 20.3 (3) shall be the annual net income for their most recent taxation year that ended before the beginning of the fiscal period in respect of which their application is made.

(5) The combined annual net income for an eligible person and their spouse referred to in paragraph 2 of subsection 20.3 (3) shall be determined based on each person’s annual net income for their most recent taxation year that ended before the beginning of the fiscal period in respect of which their application is made.

(6) Despite subsections (4) and (5), an eligible person may elect, for the fiscal period that began on April 1, 1997 and ended on July 31, 1998, to have their annual net income and, if applicable, the annual net income of their spouse, be their annual net income for the 1995 taxation year.

(7) Despite subsection (4), an eligible person who meets the criteria in paragraph 1 or 3 of subsection 20.3 (3) may elect to have their individual annual net income determined based on their annual net income for the taxation year immediately following the most recent taxation year that ended before the beginning of the fiscal period in respect of which their application is made if the election would result in a difference of 10 per cent or more in their individual annual net income.

(8) Despite subsection (5), an eligible person who meets the criteria in paragraph 2 of subsection 20.3 (3) may elect to have their combined annual net income with their spouse determined based on each person’s annual net income for the taxation year immediately following the most recent taxation year that ended before the beginning of the fiscal period in respect of which their application is made if the election would result in a difference of 10 per cent or more in their combined annual net income.

(9) Subsections 4 (6) and (7) apply to the determination of the annual net income in the case of an election under subsection (7) or (8) of this section.

20.5 (1) This section sets out the rules for determining the annual net income thresholds for the purposes of subsection 20.3 (3).

(2) For applications that relate to a fiscal period that begins before August 1, 2024, the income thresholds that apply to an eligible person’s application for relief from the section 20.2 maximum co-payment are the applicable individual or combined thresholds that were set out in this Regulation on the first day of the fiscal period to which the application relates.

(3) For applications that relate to a fiscal period that begins on August 1, 2024 or on August 1, 2025, the income thresholds that apply to an eligible person’s application for relief from the section 20.2 maximum co-payment are the following:

1. The individual annual net income threshold is $25,000.

2. The combined annual net income threshold is $41,500.

(4) For applications that relate to a fiscal period that begins on or after August 1, 2026, the income thresholds that apply to an eligible person’s application for relief from the section 20.2 maximum co-payment shall be adjusted by taking the amount calculated using the following formula and rounding it up to the next highest 10 dollars:

A + {A × [(B/C) – 1]}

in which,

  “A” is the income threshold for the preceding fiscal period,

  “B” is the average Consumer Price Index for Ontario (All Items), as published by Statistics Canada under the authority of the Statistics Act (Canada), for the 12-month period that ended on December 31 of the previous year, and

  “C” is, subject to subsection (6), the average Consumer Price Index for Ontario (All Items), as published by Statistics Canada under the authority of the Statistics Act (Canada), for the 12-month period preceding the 12-month period mentioned in the description of “B”.

(5) Despite subsection (4), if the adjustment under that subsection would result in a lower threshold for a fiscal period than in the previous fiscal period, the income threshold for the fiscal period shall not be adjusted and shall instead remain at the same amount as for the previous fiscal period.

(6) If no adjustment to the income threshold occurs for a fiscal period due to the application of subsection (5), then, for the first subsequent fiscal period for which an adjustment is to occur, the value of “C” in subsection (4) shall instead be equal to the value of “B” that was used for the most recent prior increase to the income thresholds under subsection (4).

(7) The Ministry shall publish the threshold amounts determined in accordance with subsection (4) or (5), as applicable, on a website of the Government of Ontario.

Commencement

6. (1) Except as otherwise provided in this section, this Regulation comes into force on the later of July 1, 2026 and the day this Regulation is filed.

(2) Section 2 and subsections 4 (1) and (2) are deemed to have come into force on July 1, 2025.