Ontario Drug Benefit: Who Can Get Free Prescription Drugs

Ontario Drug Benefit (ODB) Program

The Ontario Drug Benefit (ODB) program helps eligible Ontario residents pay for prescription drugs. It covers over 5,900 medications on the ODB Formulary and nearly 1,500 additional products through the Exceptional Access Program (EAP).

Who Qualifies?

Seniors 65+

You may automatically qualify when you turn 65. The government sends a letter about 3 months before your birthday, and you join on the first day of the month after you turn 65. If your income is below a threshold, you can apply for the Seniors Co-Payment Program to reduce deductible and co-payment to max $2. You must be an Ontario resident and fill prescriptions in Ontario.

Under 65

You may qualify if you:

• Live in a long-term care home or Community Home for Opportunity (requires health card number)
• Are 24 or younger with no private insurance (via OHIP+)
• Receive professional home and community care
• Receive Ontario Works or ODSP benefits
• Are enrolled in the Trillium Drug Program

Some categories require an Ontario health card number.

What's Covered?

• Allergy shots and epinephrine injectables (100% covered, but allergy shots need a Special Authorization Allergen form)
• Diabetes testing strips (with annual limits based on treatment)
• Some over-the-counter drugs if prescribed and on formulary or EAP
• Nutrition products (must be sole source of nutrition and prescribed)
• Palliative care drugs (e.g., high-strength narcotics)
• Smoking cessation drugs (for 18+)

What's Not Covered?

• Drugs bought outside Ontario
• Drugs not on the ODB Formulary or not approved by EAP

Brand vs. Generic

ODB usually covers the lower-cost option (generic). Brand-name may be covered if generic is unavailable or if you've had adverse reactions to at least 2 generics (requires a Side Effect Reporting Form and "no substitution" on prescription).

Limited Use Drugs

Some drugs are covered only under special circumstances and require a three-digit Reason for Use code on the prescription.

Biologics and Biosimilars

ODB is transitioning from originator biologics to biosimilars. If you take certain originator drugs (e.g., Copaxone, Enbrel, Humira), you may need to switch to a biosimilar during the transition period to maintain coverage.

How to Apply

Seniors are automatically enrolled. Others may need to contact the program or provide their health card number. See the official page for details.

Official Source

• Get coverage for prescription drugs | ontario.ca