Ontario Drug Benefit (ODB) is coverage for seniors (over 65) and patients with drug cards (social assistance, disability etc). For seniors, coverage automatically begins the month after he/she turns 65 years old (i.e. birthday is May 12th, coverage begins June 1st). All seniors with a health card is automatically enrolled in the standard coverage. Standard coverage requires seniors to pay $100 deductible once a year (the ODB year runs Aug 1st to July 31st) by paying for the first $100 of their prescriptions. After that, each prescription will cost $6.11 (which can be reduced to $4.11 if patient asks) for drugs listed in the ODB Formulary. Drugs not listed in the Formulary are not covered and will not count to the $100 deductible.
Seniors who’s net income is less than $16,018 (single) or less than $24, 175 (combined with spouse), should apply for $2 co-payment. Applications can be obtained from the pharmacy. Seniors who qualify will have their status changed in ODB’s system and when claims are sent for covered drugs, there is only a $2 co-payment for each prescription which the pharmacy will waive. There is no $100 deductible for senior who quailfy.
Trillium is provincial coverage available to all patients. The deductible for this program is calculated based on a patient net income. Applications can be found in the pharmacy. Trillium is best suited for patients with high drug costs in comparison to their net income. Patients will be advised of their deductible by Trillium which is collected every 3 months (i.e if patient deductible is $1000, $250 will be collected starting Aug 1st, Nov 1st, Feb 1st and May 1st in the same manner as the Senior’s $100.
To enter ODB or Trillium drug plans in Nexxsys, you will need the patient’s health card number. Use DB for ODB and TR for Trillium. Remember to inclued the version letters if available.
To check the eligibility of a product, use the ODB Formulary website: