Overview

If you have high prescription-drug costs — compared to your household income — you might qualify for the Trillium Drug Program

Who should apply

You should apply if you:

  • live in Ontario
  • have a valid Ontario health card number
  • do not already qualify for the Ontario Drug Benefit program (for example, you are not enrolled in a program such as Ontario Works)
  • do not have an insurance plan that pays for 100% of your drugs
  • spend about 4% or more of your after-tax household income on prescription-drug costs

What is covered

The Trillium Drug Program covers the cost of about 5,000 prescription drugs that are currently available through the Ontario Drug Benefit program, and about 1,000 drug products upon meeting specified criteria through the Exceptional Access Program.

Search for covered drugs

Defining your household

You have to apply for the Trillium Drug Program (TDP) as a household. You can apply to the TDP for yourself, if you live alone or you live only with people not listed below. Otherwise, you have to include:

  • your spouse, if:
    • you are married to that person
    • you are not married to that person but are living in a conjugal relationship with that person and have cohabited together for at least 1 year
    • you are not married to that person, but are living in a conjugal relationship with that person and are the parents of a child
    • you are not married to that person but are living in a conjugal relationship and have entered into a cohabitation agreement under Section 53 of the Family Law Act
  • another person, if you live together, one of you is a parent, grandparent or the legal guardian of the other, and one of you is dependent for support on the other, including if one of you is under 25 years of age who is eligible for OHIP+ if that person is dependent on the other person for support

How to apply

The Trillium Drug Program year is from August 1 to July 31. Make sure you apply by September 30 to be reimbursed for any eligible drug you received in the previous program year (August 1–July 31).

To avoid unnecessary delays and ensure timely processing, complete the Trillium Drug Program Application available on the Ontario Drug Benefit Program Online Applications and Forms website. The online form will guide you through the application process to ensure all the information required for enrolment is provided before submission.

You may also refer to the TDP Guide to help you complete the application.

If you do not have access to a computer, you can also ask for the form to be mailed to you. You can request a paper copy of the TDP form and guide by:

Once you are enrolled, you will receive a confirmation letter telling you what your deductible is for the year. Your household’s enrollment will be renewed automatically every year if you file your income taxes on time, and you will receive an annual confirmation letter.

Tell your pharmacist, doctor or nurse practitioner

Tell your pharmacist, doctor, or nurse practitioner if you’re planning to apply, have applied or have been approved for coverage through the Trillium Drug Program, so they can plan ahead to make sure that, when needed, they prescribe to you one of the drugs covered by the Ontario Drug Benefit Program.

What you pay

The deductible is the amount you pay out-of-pocket, on the first eligible drugs you buy, before your coverage begins. Your confirmation letter will include the amount of your annual deductible and list all the household members included in the coverage.

Once you’ve paid the deductible (usually about 4% of your household income after taxes), your Trillium Drug program coverage begins and you will only pay up to $2 for each drug that is filled or refilled until the end of the program year.

Calculating the deductible

For most people, the deductible for the Trillium Drug Program equals about 4% of the household income after taxes.

Your household income is the net income you reported to the Canada Revenue Agency for the previous tax year — the amount shown on line 236 of your Notice of Assessment — minus any amount you withdraw from your Canadian Registered Disability Savings Plan (amount shown on line 125 of your tax return).

Only money you pay counts towards your deductible

Only money that members of your household have spent out-of-pocket on eligible drugs can be counted as deductible payments. This means that when someone other than you (for example, private insurance, a drug company or a drug discount card) pays for all or a part of the drug cost, this portion will not count as a deductible payment.

The deductible is spread over quarters

Rather than ask you to pay the whole annual deductible at the start of the year, we divide it into four equal amounts (quarterly deductible), and we divide the program year into four equal periods (quarters). As each new quarter begins, you will pay for your prescription drugs out-of-pocket until you have paid off your deductible for that quarter. After that, your Trillium Drug Program coverage will begin and will continue until the end of that quarter.

The quarters are:

  • First quarter: August, September, October
  • Second quarter: November, December, January
  • Third quarter: February, March, April
  • Fourth quarter: May, June, July

If you don’t meet your quarterly deductible

If you do not buy enough prescription drugs to meet your deductible before a quarter is over, we will carry your unpaid deductible over to the next quarter.

For example, if your deductible for the first quarter is $25 but you bought only $20 worth of drugs in that quarter, you will pay $20 toward your deductible, and the remaining $5 will be carried over to the second quarter. So, for the second quarter, your quarterly deductible will be $25 + $5 = $30.

Your unpaid deductible will only carry over to the fourth quarter, not into the next year.

If your income changes

If your household income has changed by 10% or more, the Trillium Drug Program will recalculate your deductible on request.

Please complete the “Annual Deductible Re-Assessment Request” form and send the completed form with all supporting documentation to the Trillium Drug Program for processing. For examples of documents to include please refer to the form above.

When the ministry receives your documents, we will re-assess your household deductible and send you a letter to tell you the new amount.

How to get a 3 month supply

If you are on the Trillium Drug Program, you can request a 3 month supply of some drugs used to treat certain chronic conditions, such as:

  • diabetes
  • high cholesterol
  • high blood pressure

Getting a 3 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 learn how to request a 3 month supply.

Get Trillium Drug Program 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, oxycodone, Dilaudid, Xanax, diazepam)

For travel outside Ontario

If you’re planning to travel outside the province, you may be able to get a larger supply, but you can only do this once during the Trillium Drug Program year, which is between August 1 and July 31 the following year. Keep in mind that prescriptions filled outside Ontario are not covered by the Trillium Drug 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 (this can only be done between August 1 and February 1)
  • if you have a supply of more than 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
  • 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.