01 Oct Trillium Drug Program
Do you struggle to afford the cost of your prescription medications? For many people living in Ontario, the expense is simply too great. Although many businesses offer drug coverage – many benefit plans fall short when it comes to expensive specialty drugs.
The Province of Ontario offers a solution to supplement your insurance plans called the Trillium Drug Program. Trillium is an annual provincial program that can offer relief for out-of-pocket prescription medication expenses for all Ontario residents that have a valid health card.
The Trillium Drug Program covers the cost of about 5,000 prescription drugs that are currently available through the Ontario Drug Benefit program, and about 1,000 drug products upon meeting specified criteria through the Exceptional Access Program. Use the search tool provided here to determined what drugs are covered through the Trillium program.
Who can apply for Trillium?
- You are between the ages of 25 and 64, or are 24 years of age and under and have a private plan, and
Your household spends a large portion (approximately 4% or more) of its net income on prescription drugs, and
You have a valid Ontario Health number, and
Your household does not have any insurance plan(s) that covers all of your household’s prescription drug costs.
** The Trillium is not meant to replace insurance plans at work or school, private insurance plans, or other drug benefits provided by the province.
Before your Trillium benefits kicks in, you will be asked to pay a set amount, out of pocket, towards your prescription drugs, called a deductible – approximately 4% of your total household net income. See A Guide to Understanding the Trillium Drug Program for more details. You satisfy the deductible by purchasing prescription drugs at your pharmacy and the amount you spend is recorded on the Health Network System. The deductible is spread out over the program year, which begins August 1, and becomes due at the start of each quarter. When your prescription drug purchases equal the amount of your deductible for that quarter, your Trillium Drug Program coverage kicks in and you may only need to pay up to $2 for every prescription until the next quarter.
Once approved for the Trillium Drug Program, it is important that you show your Ontario Health Card each time you purchase prescription drug products and make sure that your pharmacist and doctor know that you are registered with the Trillium Drug Program.
If you have private coverage for prescription drugs, such as under a Group Benefits plan provided by your employer, you can apply for the Trillium Drug Program if the plan does not cover all the costs of your household’s prescription drugs.
How does co-ordination with private plans work?
Co-ordination between your private coverage and the Trillium Benefit Program will be done by the pharmacist. Your private coverage is first payor, and once your quarterly deductible has been met, any unpaid balance will be submitted to Trillium. Co-ordination will be determined by the structure of your private plan – (1) Do you pay a percentage of each prescription drug or (2) Is there an annual maximum on your drug plan? See examples to follow.
You pay a percentage of each prescription drug
- Group Benefits Drug Plan provides 80% reimbursement of Prescription Drugs.
- Annual Deductible for Trillium is $1,600 based on net income of $40,000.
- Quarterly Deductible is $400.
- After you have satisfied the $400 quarterly deductible by paying the 20% that is not paid by your Group Benefits Drug Plan, co-ordination between your Group Benefits Drug Plan and Trillium will commence so that you can receive 100% reimbursement.
There is an annual maximum on your drug plan
- Group Benefits Drug Plan provides 100% coverage to annual max. of $3,000.
- Annual Deductible for Trillium is $1,600 based on net income of $40,000.
- Quarterly Deductible is $400.
- Once you have reached the $3,000 maximum, you will receive reimbursement from Trillium after you have satisfied the $400 quarterly deductible.
Co-ordinating your prescription drug program with the Trillium Drug Program ensures that you receive the highest level of coverage and protection for you and your family. Apply Today!
YOU DESERVE MORE THAN YOU THINK®