by Kathy Ryan
The Ontario Drug Benefit program (ODB), part of the Ontario Public Drug Program
Information from the Benefits & Pension Unit, McMaster University
When you reach age 65, ask your pharmacist for current coverage details of the ODB. Seniors aged 65 or more need only their Health Card to show their eligibility for ODB when going to purchase prescription drugs.
Please check your McMaster retiree benefit booklet to confirm the benefits you are entitled to. If you are eligible to claim reimbursements for prescription drug expenses through Sun Life after age 65 (depending upon your McMaster retiree plan) you may submit claims to Sun Life for deductibles and dispensing fees not covered by ODB; save up receipts to submit a reasonable amount.
All McMaster plans reimburse members for expenses incurred within a benefit year (July - June) that are submitted by the September 30th following the end of a benefit year. For example, any ODP deductibles paid from July 1, 2008 to June 30, 2009, must be submitted to Sun Life by September 30, 2009.
Information from the Ontario Ministry of Health and Long-Term Care (as at June 15, 2009)
Who? Through the ODB Program, the Ministry of Health and Long Term Care covers a portion of the cost of prescription drug products listed in the ODB Comparative Drug Index (Formulary), as well as some exceptional cases. Ontario residents belonging to one of the following groups who have a valid Ontario health card are eligible for drug coverage under the ODB Program:
- people 65 years of age and older
- residents of long-term care homes
- residents of homes for special care
- people receiving professional services under the home care program
- Trillium Drug Program registrants
- people receiving social assistance (Ontario Works or Ontario Disability Support Program assistance)
- The drug products must be prescribed by an authorized Ontario prescriber and must be listed on the formulary, including some nutritional products and diabetic testing agents.
- Drug products that are not listed on the formulary are also considered for coverage through the ministry’s Exceptional Access Program (EAP) on a case-by-case basis following a written request by a patient’s physician.
The ODB Program automatically pays for the above listed drug products for people eligible for ODB coverage if the drugs are purchased:
- in an accredited Ontario pharmacy that is on-line with the ministry’s Health Network System; or
- from an Ontario doctor licensed to sell prescription drug products who is on-line with the ministry’s Health Network System.
Under the ODB program, ODB eligible recipients may be asked to pay some portion of their prescription drug product cost as follows:
- Single seniors (people aged 65 or older) who have an annual net income above $19,300 after taxes and senior couples with a combined annual net income above $32,300 after taxes pay a $100 deductible per senior per year in ODB eligible prescription charges before they are eligible for drug coverage under the ODB program. After the $100 deductible is paid, they pay up to $6.11 toward the dispensing fee each time they fill an ODB eligible prescription.
- Seniors who have an annual net income under the above mentioned levels and all other ODB eligible recipients, including Trillium Drug Program recipients (after their Trillium deductible is paid), may be asked to pay up to $2 each time they fill a prescription for an ODB eligible drug product.
Note that for ODB deductible purposes, the benefit year starts on August 1 and ends on July 31 of the following year.
For more information see the Ontario government's Get coverage for prescription drugs, or phone the ministry INFOline at: 1-866-532-3161