The Ontario Trillium Drug Program sets a household deductible at about 4% of after-tax household income. After the deductible, each covered drug costs up to $2.
Applies in: Ontario
Apply as a household through the Ontario Drug Benefit Program online applications and forms site. The Government of Ontario says the Trillium Drug Program deductible is usually about 4% of your household income after taxes, and once you have paid it, you pay up to $2 for each covered drug that is filled or refilled until the end of the program year.
The Trillium Drug Program is Ontario's program for households whose prescription drug costs are high compared with their income. The program year runs from August 1 to July 31.
The Ontario page says you should apply if you live in Ontario, have a valid Ontario health card number, do not already qualify for the Ontario Drug Benefit program, do not have an insurance plan that pays for 100% of your drugs, and spend about 4% or more of your after-tax household income on prescription drug costs.
You apply as a household. Depending on who lives with you, the household can include a spouse and another person who lives with you, where one of you is a parent, grandparent, or legal guardian of the other and one of you depends on the other for support.
This guide covers the application process only. It gives no advice on whether you qualify.
The program covers more than 5,900 medications available through the Ontario Drug Benefit program, plus almost 1,500 additional drug products that meet specific criteria through the Exceptional Access Program. Tell your pharmacist, doctor, or nurse practitioner that you have applied, so they can plan prescriptions around the covered list where that is possible.
The deductible is the amount you pay out of pocket on the first eligible drugs you buy before coverage begins. For most people it equals about 4% of household income after taxes, worked out from line 23600 of the previous tax year's Notice of Assessment, minus any Registered Disability Savings Plan withdrawals shown on line 12500.
The annual deductible is split into four equal quarterly amounts:
In each quarter you pay for your drugs out of pocket until that quarter's deductible is paid, then coverage begins for the rest of the quarter. If you do not meet a quarterly deductible, the unpaid part carries into the next quarter, but not into the next program year. Only money your household pays itself counts toward the deductible. Amounts paid by private insurance, a drug company, or a discount card do not count.
Enrolment renews automatically each year if you file your income taxes on time.
If you paid for a covered drug, you can submit receipts online through the Ontario Drug Benefit Program Receipt Submission Form, with your Trillium file number or Ontario health card number and the official prescription receipt signed by a pharmacist. Cash register and credit card receipts do not count. Receipts can also be mailed to the Trillium Drug Program, Ministry of Health, P.O. Box 337, Station D, Etobicoke ON M9A 4X3. All receipts and supporting documents must arrive no later than October 31, three months after the program year ends.
The Ontario page states the deductible as about 4% of after-tax household income and the payment after the deductible as up to $2 per drug, but it does not publish a table that turns a specific household income into a specific deductible amount, so this guide gives no dollar deductible for any income level. The page also does not state a processing time for a new application, so this guide gives none.
For most people, the deductible is about 4% of household income after taxes. Household income is the net income reported to the Canada Revenue Agency for the previous tax year, shown on line 23600 of your Notice of Assessment, minus any amount withdrawn from a Registered Disability Savings Plan.
The program year runs from August 1 to July 31. Apply by September 30 to be reimbursed for eligible drugs received in the previous program year, and submit receipts no later than October 31, three months after the program year ends.
Complete the Trillium Drug Program application on the Ontario Drug Benefit Program Online Applications and Forms website. If you do not have access to a computer, you can ask for a paper form and guide by phone at 416-642-3038 in Toronto or 1-800-575-5386 toll free, or by email at trillium@ontariodrugbenefit.ca.
The program covers the cost of more than 5,900 medications available through the Ontario Drug Benefit program, and almost 1,500 additional drug products that meet specific criteria through the Exceptional Access Program.
No. Once you are enrolled, your household's enrolment is renewed automatically every year if you file your income taxes on time, and you receive an annual confirmation letter stating your deductible.
If your household income has changed by 10% or more, you can ask the program to recalculate your deductible by completing the Annual Deductible Re-Assessment Request form and attaching supporting documents. The new deductible takes effect from the start of the quarter in which it is recalculated.