Toolbox: Drug Coverage for Ontario Residents

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:

  • Some residents of Ontario with a valid OHIP card may have drug coverage through the Ontario Drug Benefit program. This includes (but is not limited to) those who are over the age of 65, anyone receiving social assistance, or Ontario Disability Support Program (ODSP) recipients. Please be aware that under this program you will be required to make a co-payment on each prescription. This usually ranges from $2 to about $6 depending on your coverage status. You can also receive drug coverage under Ontario Drug Benefit by applying to the Trillium Drug Program (see details below).
  • If you have a private insurance plan, be sure to check out the terms and conditions. You may have a ceiling on the total amount that the insurer will pay. Your drugs and semi-private hospital coverage may have the same ceiling, in which case you might not want to use up your coverage on the cost of a semi-private room.
  • If you have a private insurance plan, you should provide your insurance company with a list of the medications you will be taking along with the corresponding Drug Identification Numbers (DINs). This will allow your insurance provider to determine whether they will cover your transplant medications, as well as prevent any errors when they are determining your drug coverage status. Please see the Drug Identification Number (DIN) Reference in the Patient Toolbox area of the Transplant Pharmacy website for a printable list of DINs for common transplant medications.
  • If you are not a resident of Ontario, please refer to the Drug Coverage for Non-Ontario Residents section for more information.

Trillium Drug Program

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.

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