Trillium Drug Plan

What is the Ontario Trillium Drug Plan?

This prescription drug plan was put in place to address expensive prescription drug costs for people who qualify for Ontario Health Insurance Plan (OHIP) and have chronic health conditions but are not covered by Ontario Disability Support Plan (ODSP) or Ontario Works (OW). Trillium covers a portion — but not all — of your prescription drug costs. It is designed to help working people afford drug coverage.  Even though it benefits everyone with a catastrophic illness, it was put in place due to the work of HIV activists from AIDS Action Now.

How Does the Ontario Trillium Drug Plan Work?

If a person needs $10,000 worth of drugs annually and earns $50,000 per year, their deductible is 4% of their household income, which equals $2,000. Trillium pays the difference of $8,000.

You don’t pay the deductible all at once. Trillium operates quarterly, and the deductible is spread out over the course of one year. If your annual deductible is $2,000, then your quarterly deductible will be $500. Therefore, the individual is responsible for the first $500 per quarter, plus an additional $2 per drug dispensed. Trillium covers the rest of the drug costs for that quarter. The process begins again every three months.

Things to know before applying for the Ontario Trillium Drug Plan

The Ontario Trillium Drug Plan applies to prescriptions filled in the province of Ontario, ONLY.

Trillium covers an extremely wide range of medications, including most HIV medications such as Truvada and Atripla, however Trillium will only cover medications listed in the Ontario Drug Benefit Formulary. Always make sure the drug you need is listed before applying.

Registering for Trillium requires that you register your entire household, regardless of whether any of those other people require drugs. A ‘household’ does not include adults who live together but are financially independent (e.g. roommates).

Make sure your health card is valid and up-to- date. Your health card is what your pharmacist will use to ensure that you are enrolled with Trillium, and that your costs are billed to the province instead of to you.

How to Apply to the Ontario Trillium Drug Plan

Click here for a guide to applying to the Ontario Trillium Drug Benefit Program on the Ontario Central Forms Repository site: https://forms.mgcs.gov.on.ca/en/dataset/014-3693-87

A guide to help you fill in the form can be  accessed on the same site at: https://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=4&ENV=WWE&NO=014-3693-87E

(Please note you will need Adobe 8 or higher to download the form.)

You can also get the application form by calling :
416-642-3038 (Toronto area)
1-800-575-5386 (Toll Free)
1-800-387-5559 (TTY)
Emailing, faxing and mailing the filled in forms back to Trillium is permissible.

On average, applications take two weeks to one month to be processed.

Trillium Drug Coverage Example: Alex

•  Alex makes $50,000 after taxes
•  His prescription drugs cost $12,000/year, or $1000/month
•  4% of his net income is $2000
•  Alex will pay $500 quarterly (plus an additional $2 per prescription paid to the pharmacist). Trillium pays the rest.
•  Remember: The benefit year begins in August

Quick Start Guide

1. Assess your eligibility

To be eligible for Trillium you need:

• To have filed income taxes the previous year or are ready to submit proof of income
• Have OHIP coverage – a valid Ontario Health Card
• No drug coverage, or partial coverage

AND

• High drug costs

2. Calculate your deductible.

Your deductible is 4% of your net income. Click here to check out the Trillium Drug Plan Calculator to determine your deductible.

3. Fill out an application form.

Ensure that all the members of your household sign and consent to Trillium obtaining their tax records from the CRA and choose a start date that begins one day before you plan to fill your first prescription, or immediately, if you need prescription drugs right away. Trillium will reimburse you.  (Keep your receipts for this purpose.)

4. Wait for your confirmation letter

You’ll get a confirmation letter in the mail, and it will outline what your deductible is for the year. Your household’s enrollment will be renewed automatically every year if you file your income taxes on time, and you will receive an annual confirmation letter.

   5. Tell your pharmacist, doctor or nurse practitioner

Tell them you have been approved for coverage so they can prescribe drugs covered by the Ontario Drug Benefit Program.

6. Purchase medications from your local pharmacy as usual

You will be responsible for ¼ of your deductible amount each quarter, plus $2 (dispensing fee) for each medication. Trillium will cover the rest. You must present your health card and tell the pharmacy you are on Trillium each time you wish for Trillium to cover medications.

* Download PDF to computer and open with Adobe Reader to view/edit
Ensure that all the members of your household sign and consent to Trillium obtaining their tax records from the CRA and choose a start date that begins one day before you plan to fill your first prescription, or immediately, if you need drugs right away. Trillium will reimburse you.

Purchase medications from your local pharmacy as usual, once you are enrolled.

You will be responsible for ¼ of your deductible amount each quarter, plus $2 (dispensing fee) for each medication. Trillium will cover the rest. You must present your health card each time you wish for Trillium to cover medications.