Guide to Drug Coverage in Ontario

All Canadians have access to the insured health services defined by the Canada Health Act including all medically necessary hospital services, inpatient pharmaceuticals (medicines used while you are hospitalized), and medically required physician services. Prescription medicines used by individuals who are not hospitalized (outpatients) are not paid for by this system.

Note: Any resident of Ontario with valid OHIP is eligible to apply for the Trillium Drug Program if their private insurance does not cover 100% of their prescription drug costs and they are not eligible for drug coverage under the Ontario Drug Benefit Program.

The following questions will help you identify any prescription drug benefits you may be eligible for:

  • Are you?

    • An employee of a company that provides group health benefits.
    • A dependent of an employee of a company that provides group health benefits.
    • A retired person who is eligible for group health benefits/prescription drug benefits as part of a retirement package.
    • The spouse of a retired person who is eligible for group health benefits/prescription drug benefits as part of a retirement package.
    • A member of an association or agency that provides members access to group health, benefits.
    • A dependent of a member of an association or agency that provides members access to group health benefits. 
    If you answered yes to any of the above you may be eligible for prescription drug coverage through a private insurance plan (third-party plan). You should contact the Human Resources Manager at the employer / association which provides the group health benefits for more information. 

    For more information on Private Insurance/ Third-Party Insurance Click here.

  • All residents of Ontario are eligible to apply for the Trillium Drug Program (TDP) if:

    • Their private insurance does not cover 100% of their prescription drug costs;
    • They have valid Ontario Health Insurance (OHIP); and 
    • They are not eligible for drug coverage under the Ontario Drug Benefit (ODB) Program. 
    For more information on the Trillium Drug Program click here.

  • Do you belong to one of the following groups of Ontario residents and have valid Ontario Health Insurance (OHIP)?

    • People 65 years of age and older 
    • Residents of long-term care facilities 
    • Residents of Homes for Special Care 
    • People receiving professional services under the Home Care program
    • Recipients of social assistance (General Welfare or Family Benefits Assistance)
    • Trillium Drug Program recipients 
    If yes to any of the above you are eligible for prescription drug coverage under the Ontario Drug Benefit Program. For more information on ODB click here.

  • Through the Special Drugs Program, the Ministry of Health and Long-Term Care covers the full cost of certain out-patient drugs used in the treatment of specific conditions. The program covers:

    • Many drugs for the treatment of cystic fibrosis and thalassaemia 
    • AZT, ddI, ddC and pentamadine for people who are HIV positive 
    • Erythropoietin (EPO) for people with end stage renal disease 
    • Cyclosporine for people who have had a solid organ or bone marrow transplant
    • Human growth hormone for children with growth failure
    • Clozapine for treatment of schizophrenia 
    • Alglucerase for people with Gaucher's Disease 
    For more information on the Ontario Drug Benefit: Special Drugs Program click here.

  • The Ministry of Health and Long-Term Care provides benefits to Ontarians with a valid Health Card for certain outpatient drugs, supplement and specialty foods used in the treatment of specific metabolic disorders.

    For more information on the Inherited Metabolic Diseases Program click here.

  • Are you a member of First Nations (including registered Indians under the terms of The Indian Act) or Inuit?

    If yes you may be eligible for prescription drug coverage under the Non-Insured Health Benefits Program. For more information click here.

  • Are you a federal public service employee, member of the Canadian Forces, member of the Royal Canadian Mounted Police, a Member of Parliament, a federal judge, an employee of a designated agency or corporation with access to the Public Service Health Care Plan, or person receiving pension benefits based on service in one of these capacities?

    If yes you may be eligible for prescription drug coverage under the Public Service Health Care Plan. For more information click here.

  • Are you a qualified veteran, still-serving Canadian Forces member (also see question above), RCMP member (also see question above), civilian with access to Veterans Affairs Canada health benefits, or a dependant/survivor of such a person?

    If yes you may be eligible for prescription drug coverage under Veterans Affairs Canada. For more information click here.

  • Are you a refugee claimant, Convention refugee or member of the humanitarian designated classes?

    If yes you may be eligible for prescription drug coverage under the Interim Federal Health Program. For more information click here.

  • Are you a federal inmate?

    If yes you may be eligible for prescription drug coverage under Correctional Services of Canada. For more information click here.