Do I have to apply for the Ontario Drug Benefit?

Most Ontario seniors 65 and older are enrolled automatically when they turn 65 and are registered for OAS. Your ODB eligibility is linked to your health card. Show your Ontario health card (green or red-and-white) at the pharmacy and the pharmacist will look up your ODB status. You do not need a separate ODB card.

I have been paying full price for prescriptions. Can I get a refund?

If you were eligible for ODB and paid full price because your pharmacist did not check your ODB status, you may be able to submit a claim to the Ontario government for reimbursement. Contact ServiceOntario at 1-800-268-1154 or visit ontario.ca/drugs to discuss your situation. Refunds are handled case by case.

💊 Ontario Benefit — Prescription Drug Coverage

Ontario Drug Benefit (ODB) — Prescription Coverage for Ontario Seniors 65+

Q: What is the annual deductible for ODB?

For most Ontario seniors 65+, the ODB annual deductible is approximately $100 per person per year. Once you have paid that deductible through your prescription co-payments, you pay only the co-payment ($6.11 per prescription) for the rest of the year. Seniors who receive the Guaranteed Income Supplement (GIS) have no annual deductible and pay a reduced co-payment of $2 per prescription.

Q: What if my drug is not covered by ODB?

The ODB formulary (the list of covered drugs) covers thousands of medications. If your drug is not on the formulary, ask your doctor whether an equivalent covered medication exists. For drugs not on the formulary, your doctor can also apply for Exceptional Access Program (EAP) coverage on your behalf if your situation meets specific criteria. The pharmacist can tell you immediately whether a drug is covered.

What you will learn: What the Ontario Drug Benefit program covers, how much you pay per prescription, the lower costs for GIS recipients, and what to do if you have been paying full pharmacy prices without using ODB.

Margaret's story. Margaret, 73, from Barrie, Ontario, takes four prescription medications — a blood pressure pill, a cholesterol medication, a diabetes tablet, and a thyroid pill. Before she learned about ODB, she was paying approximately $280 a month at the pharmacy, which she managed by occasionally skipping doses when money was tight.

At a digital literacy session at her local library, a volunteer mentioned that Ontario seniors over 65 have their prescriptions covered by the Ontario Drug Benefit program. Margaret had been enrolled automatically when she turned 65 — she just never knew to show her health card at the pharmacy.

Starting the following month, she showed her Ontario health card and confirmed her ODB coverage. Her monthly prescription cost dropped to four co-payments of $6.11 each — $24.44 total — plus a one-time $100 annual deductible she had already passed. She has not skipped a dose since.

What Margaret tells others at the library: "I had no idea. Show your health card. Ask the pharmacist if your drugs are on ODB. That is all it took."

What Is the Ontario Drug Benefit?

The Ontario Drug Benefit (ODB) program helps eligible Ontarians pay for prescription drugs. For Ontario residents who are 65 years old or older, ODB coverage is automatic — it is linked to your Ontario health card and kicks in the month you turn 65.

ODB covers drugs listed on the Ontario Drug Benefit Formulary, a list of over 5,000 approved medications. When you present your Ontario health card at a pharmacy for a covered drug, the government pays the bulk of the cost and you pay a small co-payment.

How Much Do You Pay?

Who you are	Annual deductible	Co-payment per prescription
Ontario senior 65+ (standard)	~$100/year	$6.11 per prescription
Senior receiving GIS (Guaranteed Income Supplement)	No deductible	$2.00 per prescription
Catastrophic protection (all seniors)	Once your out-of-pocket costs reach approximately $636/year, remaining covered prescriptions cost you nothing for the rest of the year

Exact amounts change annually. Verify current co-payment and deductible amounts at ontario.ca/drugs or by calling 1-800-268-1154.

GIS Recipients Pay Less — and Nothing After the Catastrophic Cap

If you receive the Guaranteed Income Supplement (GIS), you qualify for the lowest ODB tier: no annual deductible and only $2 per prescription. If your annual prescription costs reach the catastrophic protection limit (~$636), you pay nothing for covered prescriptions for the rest of that benefit year.

If you are not yet receiving GIS but may qualify, see our GIS guide. Enrolling in GIS also reduces your ODB costs.

How to Use Your ODB Coverage

Using ODB at the pharmacy:

1 Bring your Ontario health card every time. Your ODB coverage is linked to your health card number — not a separate card. Present your health card (green or red-and-white) to the pharmacist with every prescription.

2 Confirm the drug is on the formulary. Ask the pharmacist: "Is this covered under ODB?" The pharmacist can check immediately. If it is covered, your co-payment will be applied automatically.

3 Pay the co-payment. For most seniors, this is $6.11 per prescription (or $2 if you receive GIS). The annual deductible (~$100) is paid through the first co-payments each year — after that, you pay only the $6.11 per prescription for the rest of the benefit year.

4 If you reach the catastrophic cap (approximately $636 in out-of-pocket costs in a year), tell your pharmacist. Once the cap is reached, covered prescriptions cost nothing for the remainder of the benefit year (August 1 to July 31).

What Is and Is Not Covered

Check the Formulary Before Assuming It Is Not Covered

The ODB Formulary covers thousands of medications including most common drugs for blood pressure, diabetes, cholesterol, thyroid conditions, arthritis, depression, and many others. If your pharmacist says a drug is not covered, ask whether a generic or equivalent drug is listed. The formulary is available at ontario.ca/drugs.

Common situations where ODB may not cover a drug:

The drug is not on the formulary — ask your doctor about a covered alternative, or whether an Exceptional Access Program (EAP) application is possible
The drug is over-the-counter (does not require a prescription)
The drug is for a condition excluded from the formulary (rare, listed at ontario.ca/drugs)
The prescription was written by a provider in another province

If You Have Been Paying Full Price

If you are 65 or older and have been paying full pharmacy prices, you may have been missing your ODB benefit. This happens when:

You moved to a new pharmacy and did not present your health card for ODB billing
The pharmacy did not ask for your health card or check ODB status
You were unaware of the program

What to do if you have been paying full price:

1 Start using ODB immediately. Present your health card at your next pharmacy visit. The pharmacist will look up your ODB status and apply coverage going forward.

2 Ask your pharmacist about retroactive claims. Some pharmacies can resubmit recent claims to ODB retroactively. Ask whether any of your recent prescriptions can be rebilled under ODB.

3 Contact ServiceOntario for reimbursement. If you believe you overpaid due to a system error or were eligible but not enrolled, call 1-800-268-1154 or visit a ServiceOntario location to discuss reimbursement options. Bring your receipts.

Frequently Asked Questions

Do I have to apply for ODB?

Most Ontario seniors 65 and older are enrolled automatically when they turn 65 and are registered for OAS. Your coverage is linked to your health card number. Simply present your Ontario health card at the pharmacy and ask the pharmacist to check your ODB status. No separate ODB card is issued.

If the pharmacist cannot find your ODB coverage, call ServiceOntario at 1-800-268-1154 to confirm your enrollment and resolve any issues.

What is the annual deductible for ODB?

For most Ontario seniors 65+, the annual deductible is approximately $100 per person per year (benefit year runs August 1 to July 31). Once your co-payments total $100 in a benefit year, you pay only the $6.11 co-payment per covered prescription for the rest of the year.

Seniors who receive the Guaranteed Income Supplement (GIS) have no annual deductible and pay $2 per prescription. Verify current amounts at ontario.ca/drugs.

What if my drug is not covered by ODB?

First, ask the pharmacist whether a generic or therapeutically equivalent covered drug exists — your doctor may be able to switch your prescription. If there is no covered equivalent, your doctor can apply for Exceptional Access Program (EAP) coverage on your behalf for specific medical situations.

The full formulary is searchable at ontario.ca/drugs. Not all drugs appear there — call 1-800-268-1154 for specific inquiries.

I have been paying full price. Can I get a refund?

Possibly. If you were enrolled in ODB and paid full price because ODB was not applied at the pharmacy, some pharmacies can retroactively resubmit recent claims. Contact ServiceOntario at 1-800-268-1154 to discuss reimbursement for any period when you were eligible but not receiving your benefit. Bring receipts.

💊

If you are an Ontario resident aged 65 or older, you have prescription drug coverage. The next time you pick up a prescription, show your health card and ask: "Am I on ODB?"

If you receive GIS, your ODB costs are even lower: no annual deductible and $2 per prescription. The two benefits work together — see our GIS guide.

Sources & References

Note: ODB co-payment and deductible amounts are updated annually. Verify current rates at ontario.ca/drugs or by calling 1-800-268-1154.