Updates to the Seniors Co-Payment Program

Starting August 1, 2021, eligibility thresholds for the Seniors Co-Payment Program will be updated so that more seniors have access to the program.

  • Single seniors will increase from $19,300 to $22,200
  • Senior couples with a combined annual income will increase from $32,300 to $37,100
Apply now to make sure you are enrolled before August 1.

Submitting applications and documentation during COVID-19

Due to COVID-19, the Ontario Drug Benefit Program has implemented temporary processes to apply for the Trillium Drug Program and the Seniors Co-Payment Program.

Trillium Drug Program (TDP) application

To submit a Trillium Drug Program application or supporting documentation, you can either:

If faxing or emailing, you must mail the original signed form to the TDP by Canada Post when the outbreak is over. We will update this page to tell you when you have to mail us your documents.

When you mail us the original application, please write in bold letters "Resubmit Originals" on the application form.

Seniors Co-Payment Program (SCP) application

To submit a Seniors Co-Payment Program application or supporting documentation, you can either:

If faxing or emailing, you must mail the original signed form to the SCP by Canada Post when the outbreak is over. We will update this page to tell you when you have to mail us your documents.

When you mail us the original application, please write in bold letters "Resubmit Originals" on the application form.

Who can qualify

You will qualify for the Ontario Drug Benefit (ODB) program when you turn 65 years old. Some of you will qualify before you reach that age because you’re:

For seniors (people age 65 and older), we will send you a letter about three months before your 65th birthday to let you know you will automatically join the Ontario Drug Benefit program on the first day of the month after you turn 65 years old.

The Ontario Drug Benefit program is for Ontario residents only and prescriptions must be filled in an Ontario pharmacy to be covered. Make sure your Ontario health card is valid (for example, it hasn’t expired). Your pharmacist will need your health card to confirm your eligibility for the Ontario Drug Benefit program.

What’s covered

The Ontario Drug Benefit program covers most of the cost of approximately 5,000 prescription drug products.

Search for covered drugs

It also helps you pay for:

Allergy shots and epinephrine injectable products

The Ontario Drug Benefit program covers 100% of the cost of your allergy shots and epinephrine injectable products (for example, autoinjectors), which are used in response to severe allergic reactions.

When you go to the pharmacy to get:

  • allergy shot medication, you need a prescription AND a Special Authorization Allergen form from your doctor or nurse practitioner
  • epinephrine auto-injector(s), you ONLY need a prescription from your doctor or nurse practitioner (you do not need a Special Authorization Allergen form)

Antihistamines and mixtures used in testing for allergies are not covered by the ODB program.

Diabetes products

Some products used to monitor and test for diabetes are covered by the Ontario Drug Benefit program.

This includes diabetic testing strips for measuring blood glucose (sugar) – a common product prescribed by doctors or nurse practitioners to patients living with diabetes.

Syringes and other diabetic supplies, such as lancets, glucometers, eyeglasses, dentures, hearing aids or compression stockings are not covered by the ODB program.

Diabetic testing strips

The Ontario Drug Benefit program covers the cost for a maximum number of diabetic testing strips based on your current treatment method and clinical guidelines set by the Canadian Diabetes Association.

This table shows the type of treatment and number of test strips covered.

Diabetes treatment Maximum number of strips (per year) covered
Patients managing diabetes with insulin 3,000
Patients managing diabetes using medication with higher risk of causing hypoglycemia (low blood sugar) 400
Patients managing diabetes using medication with lower risk of causing hypoglycemia (low blood sugar) 200
Patients managing diabetes through diet/lifestyle therapy only (no insulin or medications used) 200

If you want more than the maximum quantity, you must pay for it yourself.

Qualifying for other programs

Other programs help people pay for diabetic supplies, such as needles and syringes. Find out if you qualify for other coverage through:

Over-the-counter drugs

Some drugs can be purchased without a prescription (also called over-the-counter drugs), if you pay for them yourself. The Ontario Drug Benefit Program may cover the cost of these drugs but only if your physician or nurse practitioner gives you a prescription for them and if the drugs are either:

For the Exceptional Access Program to cover an over-the-counter drug:

  • you must meet the EAP program criteria
  • your doctor or nurse practitioner must send us a request for coverage
  • we must approve the request.

If you think that the cost of an over-the-counter drug should be covered, check with your healthcare provider before buying the drug to avoid out-of-pocket costs.

Nutrition products

The Ontario Drug Benefit program covers the cost of nutrition products up to a maximum dollar amount. The product must be your sole source of nutrition and be prescribed by your doctor or nurse practitioner.

Besides writing you a prescription, your doctor or nurse practitioner must fill out a Nutrition Products form for you to receive coverage, stating that the product is the sole source of your nutrition.

The Ontario Drug Benefit program does not cover the cost of a nutrition product if you’re able to eat some solid foods, as noted by your doctor or nurse practitioner. It also does not cover a nutritional product used for:

  • supplementing other foods
  • weight loss (as directed by a doctor or nurse practitioner) to treat obesity
  • managing food allergies
  • body-building
  • voluntary meal replacement
  • feeding infants with normal digestive functions

Drugs used to treat HIV/AIDS

Many drugs used to treat HIV/AIDS are covered by the Ontario Drug Benefit program for eligible Ontarians when prescribed by a doctor who is registered on the ministry’s Facilitated Access HIV/AIDS Physician list. If you do not have a doctor who is registered on this list, you will need to be referred to one.

Drugs used in palliative care

The Ontario Drug Benefit program covers some drugs used in palliative care (for example, higher strength narcotic drugs for pain). The drugs must be:

  • prescribed by a doctor or nurse practitioner on the Palliative Care Facilitated Access List
  • listed in the official Ontario Drug Benefit Formulary, Part VI-B: Facilitated Access to Palliative Care Drug Products

If your doctor or nurse practitioner is not registered on the Palliative Care Facilitated Access List, the drugs may still be covered if your doctor or nurse practitioner submits a coverage request to the Exceptional Access Program either by fax or by calling the Exceptional Access Program’s telephone request service. Note that you will also need to consult with a doctor or nurse practitioner who is registered on the Palliative Care Facilitated Access List if you are requesting a high strength opioid through the Exceptional Access Program, including the telephone request service.

What’s not covered

The following will not be covered by the Ontario Drug Benefit program:

Brand-name vs. generic drugs

When you search to check if a medication is covered, you may see that what you searched for is “equivalent to” another medication. One is the “brand" name and the other is “generic.”

When a company develops a new drug, it will have the sole right to make (based on a formula) and sell the drug (under a brand name) for a certain period of time. That’s called a patent.

When the patent ends, other companies are allowed to make and sell their own version of the drug. These are called generics and usually cost less than brand-name drugs, but they are tested and proven to work in the same way.

You can get covered for both brand-name and generic drugs, whichever costs less. But there are exceptions, such as:

  • when a generic is not yet approved for coverage under the ODB program, even though it’s available on the market (for example, the manufacturer of a generic drug has not submitted it to the ministry for approval as interchangeable with a brand-name drug)
  • when you have had adverse reactions to at least two generics

Adverse reactions to generic drugs

If you’ve had bad reactions to at least two generics, the ODB program covers the brand-name drug. In this case, your doctor:

  • fills out the Side Effect Reporting Form (PDF that you can print and take on your next visit to your doctor)
  • writes no substitution on your prescription

Once filled out by your doctor, take the form and prescription to your pharmacist. Your pharmacist submits the completed form to Health Canada, which monitors drug safety.

Limited Use drugs

If you search for a drug and it’s labelled as "Limited Use," that means it is covered only under special medical circumstances.

When you’re prescribed one of these drugs, your doctor or nurse practitioner must confirm that your circumstances require treatment with a Limited Use drug by writing a three-digit code on your prescription, called the Reason for Use code.

If you’re given a refill by your doctor or nurse practitioner, ask to make sure it’s still available for Limited Use treatment. Some Limited Use drugs are covered for days or weeks, some for a year or years, while some are approved for lifetime coverage. You should also ask your pharmacist to check.

What you pay

What you pay depends on how you qualify for the Ontario Drug Benefit program:

Seniors

Updates to the Seniors Co-Payment Program

Starting August 1, 2021, eligibility thresholds for the Seniors Co-Payment Program will be updated so that more seniors have access to the program.

  • Single seniors will increase from $19,300 to $22,200
  • Senior couples with a combined annual income will increase from $32,300 to $37,100

Apply now to make sure you are enrolled before August 1.

With the Ontario Drug Benefit program, as a senior (someone 65 years or older) you pay a portion of prescription-drug costs based on your annual income (after deductions) and marital status. You can get coverage as a single senior (including as a widowed spouse) or as a couple (includes spouses who are married, same-sex or common-law partners).

Choose the group you belong to, to find out what you pay:

Single senior with income above $22,200

A single person aged 65 years or older with a yearly income above $22,200 after deductions pays:

  • the first $100 of total prescription costs each program year (August 1 to July 31 the following year)
    • this is called the deductible and is paid down when you fill your prescriptions
  • after paying the deductible, up to $6.11 for each prescription, filled or refilled
    • this amount is called the co-payment

How it works

We will send you a letter about three months before your 65th birthday to let you know you will automatically join the Ontario Drug Benefit program. This is a good time to tell your doctor, nurse practitioner and pharmacist so they can plan ahead to make sure that, when needed, you are prescribed one of the more than 5,000 drugs approved for coverage.

Then, go to your pharmacy on the first day of the month after you turn 65 years old (for example, if you turn 65 on April 15, go on May 1). This is your official start date in the Ontario Drug Benefit program.

Don’t forget your Ontario health card to show the pharmacist.

Senior couple with combined income above $37,100

A couple (where at least one person is aged 65 or older), with a combined yearly income above $37,100 after deductions each senior is eligible for benefits and pays:

  • the first $100 per person of total prescription costs each program year (August 1 to July 31 the following year)
    • this is called the deductible and is paid down when you fill your prescriptions
  • after paying the deductible, up to $6.11 for each prescription that is filled or refilled
    • this amount is called the co-payment

Only a spouse who is a senior receives drug benefits as a senior. A spouse who is under 65 years can apply to, or remain enrolled in the Trillium Drug Program.

How it works

We will send you a letter about three months before your 65th birthday to let you know you will automatically join the Ontario Drug Benefit program. This is a good time to tell your doctor, nurse practitioner and pharmacist so they can plan ahead to make sure that, when needed,  you are prescribed one of the more than 5,000 drugs approved for coverage.

Then, go to your pharmacy on the first day of the month after you turn 65 years old (for example, if you turn 65 on April 15, go on May 1). This is your official start date in the Ontario Drug Benefit program.

Don’t forget your Ontario health card to show the pharmacist.

Calculating first-year deductible

For your first year of Ontario Drug Benefit program eligibility, depending on the month you turn 65, the deductible may be lower than $100.

That’s because the amount of the deductible is based on the number of months between your official start date (the first day of the month after you turn 65) and July 31 (the last day of the Ontario Drug Benefit program year).

For example, if you turned 65 on April 15, your official start date would be May 1. Counting from May 1 to July 31 your deductible for the first year would be $25.

Use this chart below to see what the deductible will be in your first year:

Month you were born Amount of first-year deductible
July $100.00
August $91.67
September $83.33
October $75.00
November $66.67
December $58.33
January $50.00
February $41.67
March $33.33
April $25.00
May $16.67
June $8.33

Single senior with income of $22,200 or less

If you’re a single senior, with a yearly income of $22,200 or less after deductions, you pay up to $2 for each prescription drug filled or refilled – and you do not have to pay a deductible.

Before this can take effect, you must enrol in the Seniors Co-Payment program by sending a completed application form.

Senior couple with combined income of $37,100 or less

A senior couple (where at least one person is aged 65 or older), with a combined yearly income of $37,100 or less after deductions, each senior over 65 years of age is eligible for benefits and pays up to $2 for each drug filled or refilled – and does not have to pay a deductible.

Before this can take effect, you must enrol in the Seniors Co-Payment program by  sending a completed Seniors Co-payment Program application form.

Only a spouse who is a senior receives drug benefits as a senior. A spouse who is under 65 years can apply to, or remain enrolled in, the Trillium Drug Program.

Filling out the Seniors Co-payment Program Application  

If you’re a single senior with annual income of $22,200 or less (after deductions), or a senior couple (one or both spouses 65 or older) with annual income of $37,100 or less (after deductions), you must fill out and  send the Seniors Co-payment Program application form before you can start paying the $2 co-payment, with no annual deductible.

We will send you a letter about three months before your 65th birthday to let you know you will automatically join the Ontario Drug Benefit program. The letter can be your reminder to fill out the form.

Get a copy of the application:

Mail your completed application, including all required signatures and supporting documents, to:

Ontario Drug Benefit Program
Ministry of Health
P.O. Box 384, Station D
Etobicoke, Ontario M9A 4X3

Living in a long-term care home, home for special care or community home for opportunity

If you live in one of these types of homes, you are automatically covered by the Ontario Drug Benefit program. You pay up to $2 for each drug filled or refilled – and you do not have to pay a deductible.

For those who are aged 24 and under and are living in these types of homes, you do not have to pay the $2 for each drug filled or refilled.

Ask your care coordinator or pharmacist how it works.

Receiving professional home and community care services

If you are receiving professional home and community care services arranged through your Local Health Integration Network, you are automatically covered by the Ontario Drug Benefit program. You pay up to $2 for each drug filled or refilled – and you do not have to pay a deductible.

If you are aged 24 and under and have no private insurance or are receiving professional home and community care services, you do not have to pay the $2 for each drug filled or refilled.

Ask your care coordinator or pharmacist how it works.

Receiving benefits from Ontario Works or Ontario Disability Support Program

If you receive benefits from one of these programs, you are automatically covered by the Ontario Drug Benefit. You pay up to $2 for each drug filled or refilled – and you do not have to pay a deductible.

If you are aged 24 and under and have no private insurance or are receiving benefits from one of these programs, you do not have to pay the $2 for each drug filled or refilled.

Ask your Ontario Works or Ontario Disability Support Program case worker how it works. Your pharmacist can also tell you.

How to get a refund (reimbursement)

If you forgot to tell the pharmacist you were covered by the Ontario Drug Benefit and paid for a covered drug, send us a letter that includes:

  • a note explaining that you need a refund
  • your health card number or the eligibility number on your paper drug card (if you don’t have an Ontario health card number)
  • the original (not fax or photocopy) prescription receipt (this is different from the cash register receipt) – if you’ve lost the original prescription receipt, the pharmacist can reprint it for you

If you are not in the Trillium Drug Program, mail everything to:
Ministry of Health
Ontario Drug Benefit Program
P.O. Box 384, Station D
Etobicoke ON M9A 4X3

Only if you are in the Trillium Drug Program, mail everything to:
Ministry of Health
Trillium Drug Program
P.O. Box 337, Station D
Etobicoke ON M9A 4X3

How to get a three-month supply

Under the Ontario Drug Benefit program, you can request a three-month supply of some drugs used to treat certain chronic conditions, such as:

  • diabetes
  • high cholesterol
  • high blood pressure

Getting a three-month supply of your prescription means you will pay co-payment fees less often.

Talk to your pharmacist to find out which drugs qualify and to learn how to request a three-month supply.

Coverage during travel

For travel in Ontario

Your pharmacist can transfer your prescription to another pharmacy in Ontario, as long as:

  • your prescription has enough refills on it
  • you’re not refilling it too soon (within 10 days of end of supply)
  • your prescription is not for a controlled drug, controlled drug preparation or a narcotic (for example, Percocet, Dilaudid, Xanax, Valium)

For travel outside Ontario

If you’re planning to travel outside Ontario, you may be able to get a larger supply, but you can only do this once during the Ontario Drug Benefit program year – between August 1 and July 31. Keep in mind that prescriptions filled outside Ontario are not covered by the Ontario Drug Benefit program.

Here’s how it works:

  • if you have a supply of less than 30 days, you can get a travel supply of up to 200 days
  • if you have a supply of more than or equal to 30 days, you can get a 100-day supply

Get a travel supply of medication

To get your travel supply, give your pharmacist either:

  • a letter (that you can write yourself) confirming you’re leaving the province for more than 100 days, or
  • a copy of your travel insurance policy showing you’re leaving the province for between 100 and 200 days

You have to pay the deductible or co-payment amount for the extra supply.

Updated: September 23, 2021
Published: January 01, 2018