The Ontario Drug Benefit Program and deductibles
If you or your dependant is 65 years old or older, the Ontario Drug Benefit (ODB) program can help pay for the majority of the cost of more than 4,400 prescription drug products. 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.
Do I have to pay a deductible?
Your deductible depends on how you qualify for the Ontario Drug Benefit. These categories include:
- 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
Let’s use the example of a senior. As a senior, there are four income groups to find out what you pay (after taxes):
- Single senior with income above $19,300
- Senior couple with income above $32,300
- Single senior with income of $19,300 or less
- Senior couple with combined income of $32,300 or less
Based on the information above, your annual deductible is calculated. A deductible is the amount you pay for covered health care services before your insurance plan starts to pay. If we use the example of a single senior with income above $19,300 after taxes, this person has an annual deductible of $100 that is paid down each time a prescription is filled.
When visiting the pharmacy, the pharmacist may have told you that the maximum has been reached. What this means is you have paid the full $100 deductible for the year and moving forward, will no longer be required to pay towards the deductible. Let’s take a look at what exactly the single senior would need to pay when at the pharmacy.
When filling a prescription at the pharmacy, the single senior is required to pay:
Here’s the good news! The $100 deductible is eligible for reimbursement from your RTIP/ARM plan if the medications purchased are eligible under the plan. After the deductible has been reimbursed to you by your RTIP/ARM plan, the ODB program will cover any portion of your drug claim that is covered by the provincial health plan.
To learn more about the Ontario Drug Benefit Program and deductibles, please visit Ontario.ca