As you probably know, OHIP helps Ontario seniors (people age 65 and older) and youth (24 years of age or younger who does not have a private insurance plan) to pay for prescription drugs through the Ontario Drug Benefit (ODB) program.
The Ministry of Health will send you a letter about three months before your 65th birthday to let you know you will automatically join the Ontario Drug Benefit program on the first day of the month after you turn 65 years old.
The Ontario Drug Benefit program covers most of the cost of more than 4,400 prescription drug products.
Does OHIP cover brand-name or generic prescription drugs?
When you search to check if a medication is covered, you may see that what you searched for is “equivalent to” another medication. One is the “brand” name and the other is “generic.” What is the difference?
Brand-name prescription drugs vs. generic
When a company develops a new drug, it will have the sole right to make (based on a formula) and sell the drug (under a brand name) for a certain period of time. That’s called a patent.
When the patent ends, other companies are allowed to make and sell their own version of the drug. These are called generics and usually cost less than brand-name drugs, but they are tested and proven to work in the same way.
Ontario seniors can get covered for both brand-name and generic drugs, whichever costs less. But there are exceptions, such as:
- when a generic is not yet approved for coverage under the ODB program, even though it’s available on the market (for example, the manufacturer of a generic drug has not submitted it to the ministry for approval as interchangeable with a brand-name drug)
- when you have had adverse reactions to at least two generics
If you’ve had bad reactions to at least two generics, the ODB program covers the brand-name drug but there is a special procedure for that.
Find out if your prescription medication is covered by ODB
You can check if your medication is covered or not through the Ontario Drug Benefit program. The Ontario Drug Benefit program covers most of the cost of the more than 4,400 medications you can search for on that page.
If you are covered by the ODB program and need help paying for a medication that is not found in the search tool, it may be covered through the Exceptional Access Program (EAP) or the Limited Use drugs program.
Sources:
- https://www.ontario.ca/page/get-coverage-prescription-drugs#section-5
- https://www.ontario.ca/page/check-medication-coverage/
- https://www.ontario.ca/page/check-medication-coverage/
- https://www.ontario.ca/page/applying-exceptional-access-program
