Due to the high cost of transplant medications it is essential that you arrange for medication coverage before you receive your transplant.
Please keep in mind the following considerations regarding drug coverage:
The Trillium Drug Program is a plan available to all Ontario residents with a valid OHIP card. It is based on family income and total drug costs. An individual or family will pay a certain amount of their drug costs (the deductible) and after that will be eligible for drug coverage for costs over and above the deductible amount. There is a sliding scale such that larger income earners pay more, but eventually they too will be eligible for assistance if their drug costs are high enough.
Applications are available through most retail pharmacies, your transplant coordinator, or your social worker. Adults who live with their parents can have their income considered as an individual provided they can establish their independence, i.e., they pay rent. Patients who have independent adult children living with them do not have to include their children's income as part of the family income.
The TGH Multi-Organ Transplant Program requires that all Ontario pre- and post-transplant patients maintain an active registration with Trillium. Because the drugs required after transplant are very expensive, Trillium registration is necessary even if you have 100% private coverage through your employer. Special requests must often be made to private insurers to cover certain drugs. In the event that such a request is denied, a Trillium registration number would be required in order to obtain coverage for these medications. If you are not registered with Trillium and cannot provide this number you will have to pay for the medication yourself out-of -pocket. Even if you register with Trillium after the fact this amount does not count towards your Trillium deductible. In some situations this could amount to several hundred or even several thousand dollars.
There is no cost to register with Trillium and the application takes only a few minutes to complete. Registration with Trillium does not jeopardize or interfere with your private drug coverage. Patients with private coverage should continue to use it and apply for Trillium assistance for those drugs that are not covered or are only partially covered by their private insurance plan.
You are strongly encouraged to submit your Trillium application as soon as possible before your transplant as it can take several weeks for these applications to be processed.
Please also be aware that there is a small co-payment for each prescription obtained through the Trillium Drug Program after your deductible is reached. Some retail pharmacies may choose to waive or reduce this fee.