Prescription Drug Coverage in Ontario
Reviewed by the Commoner Law Editorial Team. Sourced from Canadian federal statutes and official sources. Provincial information reflects each province's own legislation and court rulings. Written in plain language for general understanding — this is educational content, not legal advice. Our editorial standards
What is this right?
Unlike hospital and physician services, prescription drugs are not universally covered under the Canada Health Act when dispensed outside a hospital. Coverage comes from a patchwork of provincial plans, federal programs, and private insurance.
Every province has a public drug plan, but eligibility varies. Most cover seniors, social assistance recipients, and people with high drug costs relative to income.
Federal programs include:
- NIHB — Non-Insured Health Benefits for First Nations and Inuit
- Veterans Affairs coverage
- IFHP — Interim Federal Health Program for refugees
- Coverage for federal inmates
The Pharmacare Act (2024) launched phase 1 of national pharmacare, covering contraceptives and diabetes medications. These benefits are rolling out through 2025-2026 via provincial bilateral agreements. About two-thirds of Canadians also have employer-sponsored drug coverage.
When does it apply?
- Eligibility depends on the specific program — provincial plans cover certain demographics, and national pharmacare phase 1 is rolling out gradually.
- About two-thirds of Canadians have some form of employer-provided drug coverage.
What to Do If You Can't Afford Prescription Drugs in Canada
- Check your provincial drug plan eligibility — you may qualify and not know it.
- Apply for your province's program — Trillium in Ontario, Fair PharmaCare in BC, or the equivalent in your province.
- Ask your pharmacist about pharmacare coverage for diabetes medications and contraceptives under the new national program.
- Register for NIHB if you are First Nations or Inuit.
- Keep all pharmacy receipts — you can claim the medical expense tax credit on your tax return for eligible drug costs.
What should you NOT do?
- Don't assume you have no coverage — many people are eligible for provincial programs but have never enrolled.
- Don't skip medications because of cost — talk to your pharmacist about generic alternatives or assistance programs.
- Don't confuse hospital drug coverage with outpatient coverage — drugs given in hospital are covered, but the same drug dispensed at a pharmacy may not be.
- Don't overlook federal tax credits — the medical expense tax credit can help offset high drug costs.
How Ontario differs from federal law
OHIP does not cover prescription drugs at the pharmacy, but Ontario has several provincial programs that provide drug coverage to specific populations.
- The Ontario Drug Benefit (ODB) Program provides prescription drug coverage to: seniors aged 65 and over, people receiving Ontario Works (social assistance) or Ontario Disability Support Program (ODSP) benefits, residents of long-term care homes and certain home care recipients, and people with high drug costs relative to income through the Trillium Drug Program.
- OHIP+ provides free coverage of approximately 5,000 prescription drug products to children and youth aged 0 to 24 who do not have private insurance. If you have private insurance, OHIP+ does not apply and your private plan pays first.
- The Trillium Drug Program helps Ontario residents with high prescription drug costs. If your drug costs are roughly 4% or more of your net household income and you don't qualify for ODB, you may qualify for Trillium. You pay a deductible based on income.
- Seniors on ODB pay a co-payment of up to $6.11 per prescription (or $2.00 per prescription if your income is below approximately $22,200 for single, $37,100 for couples and you apply for the Seniors Co-Payment Program).
- The ODB Formulary lists all drugs covered by Ontario's public drug programs. Not every drug is on the Formulary — if your drug is not listed, your doctor can request Exceptional Access.
Additional Steps in Ontario
Seniors are automatically enrolled in ODB when they turn 65 — bring your OHIP card to the pharmacy. For OHIP+ (children and youth), no application is needed if you don't have private insurance. For the Trillium Drug Program, apply online at ontario.ca/page/get-help-high-prescription-drug-costs or call 1-800-575-5386. If your drug is not on the Formulary, ask your doctor to submit an Exceptional Access Program (EAP) request to the Ministry of Health.
Relevant Law: Ontario Drug Benefit Act, R.S.O. 1990, c. O.10; O. Reg. 201/96 (General Regulation under ODB Act); Ontario Regulation 201/96, as amended (OHIP+)
Common Questions
When does prescription drug coverage apply?
Eligibility depends on the specific program — provincial plans cover certain demographics, and national pharmacare phase 1 is rolling out gradually.About two-thirds of Canadians have some form of employer-provided drug coverage.
What should I do if I can't afford my prescription medications in Canada?
Check your provincial drug plan eligibility — you may qualify and not know it.Apply for your province's program — Trillium in Ontario, Fair PharmaCare in BC, or the equivalent in your province.Ask your pharmacist about pharmacare coverage for diabetes medications and contraceptives under the new national program.Register for NIHB if you are First Nations or Inuit.Keep all pharmacy receipts — you can claim the medical expense tax credit on your tax return for eligible drug costs.
What mistakes should I avoid with prescription drug coverage?
Don't assume you have no coverage — many people are eligible for provincial programs but have never enrolled.Don't skip medications because of cost — talk to your pharmacist about generic alternatives or assistance programs.Don't confuse hospital drug coverage with outpatient coverage — drugs given in hospital are covered, but the same drug dispensed at a pharmacy may not be.Don't overlook federal tax credits — the medical expense tax credit can help offset high drug costs.
Legal Resources
We may earn a commission if you use these services — at no extra cost to you. This supports our mission to make legal information free for everyone.