#FinancialFridays: Prescription Drug Costs for Seniors

***NOTICE: Income Level Changes for the Seniors Co-Payment Program

  • Single Senior Income – from $22,200 to $25,000
  • Senior Couple Combined Income – from $37,100 to $41,500
    • This change is for August 1st, 2024.
    • You can apply for the 2024/2025 program year based on the new income thresholds starting in May 2024.

When you turn 65, you can use the Ontario Drug Benefit, to cover most costs for prescription drugs. The benefit is connected to your Ontario Health Insurance Plan (OHIP) card. There is a list of around 5,000 prescription drugs that are covered in Ontario: https://www.ontario.ca/check-medication-coverage/

  • If you are a senior and your income is above $25,000 after deductions,
    • you will pay the first $100 of total prescription costs each year (starting August 1st each year).  This is called the deductible.
    • After the $100 deductible is paid, you will pay up to $6.11 for each prescription that is filled or refilled. This is called the “co-payment”.
  • If you are one of a senior couple with a combined income above $41,500 after deductions,
    • you will each pay the first $100 of your own total prescription costs each year. This is called the deductible.
    • After the $100 deductible is paid, you will pay up to $6.11 for each prescription that is filled or refilled. This is called the “co-payment”.

The income levels are based on your income tax return for the previous year (2023 income tax filing for the 2024/2025 program year).

For the first year that you get the Ontario Drug Benefit your deductible may be lower than $100. This depends on the month you turn 65. The deductible amount is based on the number of months between your official start date (the first day of the month after you turn 65) and July 31st (the last day of the Ontario Drug Benefit program year).

Seniors with incomes lower than those mentioned above can apply for the Seniors Co-Payment Program. This program:

  • waives the $100 deductible and
  • lowers the per-prescription cost to $2.

Applying for the Seniors Co-payment Program

  • You can apply for this program three months before you turn 65 throughout the year.
  • If your household’s income has been verified by the Canada Revenue Agency, you do not need to re-apply every year. You do this by giving the Canada Revenue Agency consent to share your income information with the Ontario Ministry of Health and Long-Term Care.
  • If you are enrolled based on another proof of income, you will need to provide updated income documentation to the program each year.
    • If you filed your income taxes, send a copy of your Notice of Assessment (NOA) to the program to confirm your household’s income. Until the NOA is received by the ministry, your eligibility will end on July 31st.

Visit this website to get the application for the Seniors Co-Payment Program: https://forms.ontariodrugbenefit.ca/portal/EFormUpdate.aspx?usid=7b0c2cfe-6a7b-4d7e-8149-1700813ee01a&eFormId=600a8fe9-059f-4688-a358-3e9af217b5bc&DomainID=e98ae7fc-3a6c-42aa-8845-b6b165a4dd9c