This is an Ontario program that helps residents of that province to defray the cost of prescription drugs. There are a lot of restrictions – you are most likely to qualify if you have a very low income or must take expensive drugs on a regular basis due to an ongoing disease or condition.
What is the Trillium Drug Program?
The Trillium drug plan helps Ontario residents to cover the cost of about 5,000 prescription drugs. In addition, there are about 1,000 products under the Exceptional Access Program.
Who is eligible for the Trillium drug plan?
You must be a resident of Ontario and have a provincial health card. As well, you must meet the following requirements:
- You do not already qualify for the Ontario Drug Benefit
- You do not have an insurance plan that pays 100 percent of your prescription drug costs
- You spend 4 percent or more of your after tax household income on drugs.
Let’s suppose you have a prescription drug plan through your employer. It reimburses you for a maximum of $450 of drugs per year. You could be eligible for Trillium but would need to deduct the amount paid by your plan before receiving any benefit.
On the other hand, the Ontario Drug Benefit (ODB) covers a number of people. If you fall into one of these groups, you will get coverage from the ODB rather than Trillium:
- Children
- Seniors
- Ontario Works recipients
- Ontario Disability Support Program recipients
What is the income limit for the Ontario Trillium drug benefit?
There is no specific maximum income to qualify for the Ontario Trillium drug benefit. However, the deductible can be quite high, which means that only those with low incomes or very high drug costs are able to participate. Here’s how it works:
When you enroll, you have to pay the deductible before receiving any benefits. The deductible is about 4 percent of your household after tax income.
Let’s look at an example. Suki and James have an after tax household income of $50,000. Unfortunately, James has kidney failure and spends about $3,000 per year on prescription drugs. Their deductible is 4 percent of their net income – or $2,000. They would have to pay the deductible before receiving any Trillium benefit. In their case, they would receive $1,000 per year (the $3,000 cost less their $2,000 deductible).
Once you have paid your deductible, you only have to pay $2 for each prescription filled.
If your income has changed by more than 10 percent you can request a reassessment. For example, Marc recently lost his job and his income dropped dramatically. As a result, he submitted a form to have his deductible reduced. The Ontario government approved his request and he is able to get reimbursement for a larger share of his drug costs.
What’s covered under the Trillium Drug Program?
The program includes about 5,000 drugs. You can view the listed drugs on the province’s Formulary page. If your prescription is not included on the list, you may still be able to get coverage under the Exceptional Access Program.
When does the Trillium deductible start?
The program runs from August 1 to July 31 each year. It is based on your household after tax income from the previous year. You can find this information on Line 236 of your Notice of Assessment from the Canada Revenue Agency.
If you have a Canada Disability Savings Program, any withdrawals are subtracted from this amount.
Deductibles are calculated on a quarterly basis. For example, let’s say your annual deductible is $1,000 based on your income. This means that your quarterly deductible will be $250. When purchasing prescription drugs each quarter, you would pay the first $250. After that, the Trillium program would provide coverage.
Even though the program starts on August 1, you can still join at other times. For example, suppose you register on February 1 and your annual deductible is $1,000. Since this is halfway through your program year, your deductible would only be $500. You would be eligible for benefits once you have paid this amount for prescription drugs.
How long does it take to get Trillium drug benefits?
The Ontario government does not promise how long it will take to process your application. However, the good news is that you can apply up until September 30 for coverage in the previous program year (which runs from August 1 to July 31). The province is firm on this deadline – so be sure to get your application in on time.
Trillium drug program application
As you can imagine, the Trillium drug plan has a lot of rules and restrictions. Be sure to read the application carefully to see if you qualify. Provide all the requested information and documents – a missing item could cause a delay in approving your Trillium benefit.
In summary: The Trillium Drug Program
If you need help with your prescription drug costs and live in Ontario, be sure to look into both the Ontario Drug Program and the Trillium Drug Program. The Ontario plan covers the widest range of people, including seniors, children, the disabled and those on Ontario Works. The Trillium plan is more focused on those with lower incomes who have large prescription drug expenses every year.
