Does OHIP help seniors paying for brand-name or generic prescription drugs?

As you probably know, OHIP helps Ontario seniors (people age 65 and older) to pay for prescription drugs through the Ontario Drug Benefit program. The Ministry of Health will send you a letter about three months before your 65^th birthday to let you know you will automatically join the Ontario Drug Benefit program on the first day of the month after you turn 65 years old.

Brand-name prescription drugs vs. generic

When you search to check if a medication is covered, you may see that what you searched for is “equivalent to” another medication. One is the “brand” name and the other is “generic.” What is the difference?

When a company develops a new drug, it will have the sole right to make (based on a formula) and sell the drug (under a brand name) for a certain period of time. That’s called a patent.

When the patent ends, other companies are allowed to make and sell their own version of the drug. These are called generics and usually cost less than brand-name drugs, but they are tested and proven to work in the same way.

Ontario seniors can get covered for both brand-name and generic drugs, whichever costs less. But there are exceptions, such as:

• when a generic is not yet approved for coverage under the ODB program, even though it’s available on the market (for example, the manufacturer of a generic drug has not submitted it to the ministry for approval as interchangeable with a brand-name drug)
• when you have had adverse reactions to at least two generics

If you’ve had bad reactions to at least two generics, the ODB program covers the brand-name drug but there is a special procedure for that.

Limited Use drugs

If you search for a drug and it’s labelled as “Limited Use,” that means it is covered only under special medical circumstances.

When you’re prescribed one of these drugs, your doctor or nurse practitioner must confirm that your circumstances require treatment with a Limited Use drug by writing a three-digit code on your prescription, called the Reason for Use code.

If you’re given a refill by your doctor or nurse practitioner, ask to make sure it’s still available for Limited Use treatment. Some Limited Use drugs are covered for days or weeks, some for a year or years, while some are approved for lifetime coverage. You should also ask your pharmacist to check.

Sources:

https://www.ontario.ca/page/get-coverage-prescription-drugs#section-5

https://www.ontario.ca/page/check-medication-coverage/

https://www.ontario.ca/page/check-medication-coverage/

https://www.ontario.ca/page/applying-exceptional-access-program