What you need to know about the Ontario Drug Benefit program at 65
June 27, 2018
Turning 65? As an Ontario resident, this means that you will qualify for the Ontario Drug Benefit (ODB) program, and can enjoy the flexibility of different plans offered by Retired Teachers Insurance Plan (RTIP).
The ODB program covers the majority of the cost for more than 4,300 prescription drug products for Ontario residents.1 The program can also help you pay for allergy shots and EpiPen®, some diabetes monitoring and testing products, some prescribed over-the-counter drugs and some nutrition products.
To find out which products are covered by the ODB program, you can search the Ontario Ministry of Health Formulary online.2 However, the Ministry recommends verifying which products are covered under the ODB program with your pharmacist, doctor or nurse practitioner because some of the information is technical.
In order to be eligible for the program you must be a resident of Ontario, and must be able to provide a valid (i.e. not expired) health card to your pharmacist. The prescription must also be filled at an Ontario pharmacy.
The ODB program requires those eligible to pay an $100 deductible if their income is over the provincial threshold. This means that the ODB program would not be activated until those over the income threshold have first spent $100 out-of-pocket on prescription drugs.
This $100 deductible is eligible for reimbursement from RTIP, so long as the medications purchased are eligible under your plan. Once the deductible has been reimbursed by RTIP, the ODB plan would then cover any portion of drug claims that is covered by the provincial health plan.
Since the ODB program may cover the majority of your prescription costs once you turn 65, RTIP offers its members the flexibility to decrease their coverage and change plans at that time. This flexibility protects you from getting stuck paying for more prescription drug coverage than you need.
Call your pharmacist to determine the annual cost of your prescription drugs that are not covered under the ODB program. Use that number to find the coverage that is right for you. At your next renewal you can opt to decrease your prescription drug coverage, therefore reducing your monthly premiums.
RTIP offers multiple plans to accommodate your needs as they change throughout your retirement. When they do, you’ll be able to increase or decrease your coverage at your next renewal.
If you would like to know more about RTIP’s flexibility or have any questions, view the Health, Dental and Travel Insurance available to you, or contact a Life and Living Benefits Representative at 1-800-267-6847