Ontario Drug Benefit for Seniors – Pharmacist Answers Your Commonly Asked Questions
Author: Dr. Karen Wang, PharmD, RPh
What is the Ontario Drug Benefit program for seniors?
The Ontario Drug Benefit program covers most of the cost of approximately 5000 drug products including: prescription medications, nutritional products, and products used for monitoring and testing in diabetes.
Who qualifies for this program?
You must be least 65 years old and have a valid Ontario health card.
How can I apply?
If you qualify for the program, you do not need to apply– you only need to bring your Ontario health card and prescription to your pharmacy.
The benefits will automatically come into effect on the first day of the month after your 65th birthday. For example: if your birthday is on June 23, your benefits will be effective on July 1. You will receive a letter from the government three months before your 65th birthday to let you know.
If I qualify, do I need to pay?
Depends on your previous year’s income:
Please note the Ontario Drug Benefit program benefit year starts on August 1st and ends on July 31st of the following year. The 2021-2022 benefit year would start on August 1, 2021 and end on July 31, 2022.
Example:
Paul is a single senior and his 2020 income was $30 000. He is not eligible for the Senior Co-payment Program in the 2021-2022 benefit year.
In August 2021, he needs to pick up antibiotics that cost $30. Then in September, he needs to pick up blood pressure medications that cost $80.
When he picks up his antibiotics, he must pay $30. When he picks up his blood pressure medications, he only pays $70 because he has satisfied his $100 deductible for the benefit year. For the rest of the benefit year, he only pays a $6.11 co-pay for each prescription.
If Paul’s 2020 income was $20 000, he would be eligible for the Senior Co-payment Program in the 2021-2022 benefit year. After the program approves his application, he only pays a $2 co-pay for each prescription.
Many pharmacies waive $2 from the co-pay – ask your pharmacy for details.
How do I apply for the Seniors Co-payment Program?
You can find the application form at your pharmacy or online at https://www.ontario.ca/page/get-coverage-prescription-drugs and mail the completed form to the address on the form.
You can apply any time during the benefit year to 2 months after the benefit year ends. If you paid a deductible or co-pay during the benefit year before applying, you have until 3 months after the benefit year ends to send your prescription receipts to the address on the application form for reimbursement.
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