Is your prescription drug covered by OHIP?

The free access to health care and medications is a huge advantage of living in Canada. In Ontario, we are fortunate to have access to medical care, including prescriptions through the Ontario Health Insurance Plan (OHIP).

While you have access to coverage for many different types of prescriptions, you are not covered for everything. There are certain limitations as to what is and is not covered by OHIP. There are excellent governmental programs for seniors (people age 65 and older) and youth (24 years of age or younger who does not have a private insurance plan) to get help paying for prescription drugs – the Ontario Drug Benefit (ODB) program.

Medications covered by OHIP

• Antibiotics to treat infections.
• Inhalers for asthma.
• Various insulins, oral diabetic medications, and diabetes test strips.
• Epinephrine injectable products (e.g. auto-injectors)
• Drugs to treat arthritis, epilepsy, and other chronic conditions.

There are other medications that are covered that do not appear here. Speak with your doctor or pharmacists if you have questions about coverage for a specific type of drug or medication.

How to check if your medication is covered

 In total, there are about 5,000 different medications that are partially or almost fully covered. If you are not sure if your medication is covered, you can do an online search on the Ontario.ca website. Simply enter a medication name, ingredient, or Drug Identification Number (DIN) in the search box. It will tell you what type, brand, and dosage is covered.

Have more questions about your medication or how OHIP works? Ask your doctor or pharmacist. They will help you with all your medication questions.

The Ontario Drug Benefit Program

The Ontario Drug Benefit program covers most of the cost of more than 4,400 prescription drug products.

 You will qualify for the Ontario Drug Benefit program when you turn 65 years old. 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.

This program is for Ontario residents only and prescriptions must be filled in an Ontario pharmacy to be covered. You must have your valid OHIP card to get prescription drugs at a pharmacy: your pharmacist will need your health card to confirm your eligibility.

Who else qualify for the Ontario Drug Benefit program

 Some Ontarians qualify for ODB before they reach 65:

• living in a long-term care home, home for special care, Community Home for Opportunity
• 24 years of age or younger and not covered by a private insurance plan
• receiving professional home and community care services
• receiving benefits from Ontario Works or Ontario Disability Support Program
• enrolled in the Trillium Drug Program

What is not covered by ODB

 The Ontario Drug Benefit program does not cover the following:

• prescription drugs that you buy outside Ontario
• drugs that are not listed on the official Ontario Drug Benefit Formulary/Comparative Drug Index, or are not approved by the Exceptional Access Program

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