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Ontario Drug Benefit Case Study

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Ontarians have access to health services through the Ontario Health Insurance Plan (OHIP), but OHIP doesn’t cover everything. OHIP doesn’t provide coverage for prescription drugs. That means your employees need to pay out of pocket to get the prescription drugs they need. Some drugs are very expensive, so even employees with high salaries could struggle to pay for medications.
You may provide some coverage for prescription drugs through your employee benefits plan. But since your budget isn’t unlimited, you may only be able to provide partial coverage for prescription drugs. You may have a yearly coverage limit that isn’t enough for a few of your employees. Fortunately, there’s an Ontario program that can help fill the gaps. This program is …show more content…
The Trillium Drug program is designed for people who need expensive prescription drugs. People who spend around three to four percent of their income on medications (or more) can qualify.
What the Program Pays for
The Ontario Drug Benefit program covers most of the cost of eligible prescriptions. In addition to prescription medications, the plan also covers things like diabetes testing strips. Employees can receive a certain number of testing strips per year depending on the type of diabetes treatment they’re receiving.
About 4,400 different prescription medications are covered by the plan. The Ontario government publishes all the drugs that are covered by the plan online. If your employees are wondering if specific drugs are covered, they can search the Formulary.
When employees go to the pharmacy to pick up their prescriptions, they just need to pay a co-pay. That makes it much easier for employees to afford their expensive prescriptions. If employees are receiving coverage through the Trillium Drug Program, they’ll need to pay a deductible to the government every quarter. This deductible is around four percent of the last year’s net

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