OHIP+ covers the cost of PrEP for Ontarians 24 years old and younger with a valid OHIP card and no private drug coverage. If you are 24 years old or younger, have a valid OHIP health card, and do not have private drug coverage, OHIP+ automatically covers you. Show your OHIP card to the pharmacist, and you will only have to pay up to $2 each time you fill your prescription. As of April 1, 2019, OHIP+ will not cover the cost of PrEP for Ontarians 24 years old and younger who already have private drug coverage.
Ontarians age 65 and older who have a valid OHIP card are covered for PrEP.
If you are 65 years old or over and have a valid OHIP card, you are covered by Seniors Coverage.
This program provides different levels of coverage based on your household income:
If you are single and earn $19,300 or less after taxes or are part of a couple with a combined yearly income of $32,300 or less after taxes, you will pay up to $2 each time you fill your prescription.
If you are single and earn more than $19,300 after taxes or you are part of a couple with a combined yearly income of more than $32,300 after taxes, you will pay the first $100 of all your prescription costs per person each year and then up to $6.11 for each prescription filled or refilled.
WHAT IS TRILLIUM DRUG PLAN?
The Trillium Drug Program helps people with high medication costs pay for PrEP. If you don’t have a drug plan or your plan doesn’t cover the full cost of your PrEP, you may be eligible for the Trillium Drug Program:
If your household’s total annual drug costs are more than 3-4% of your total household income, you can apply to the Trillium Drug Program. Your household income is based on the amount of income you earn plus the income of a partner or any other family member who you support or who supports you financially.
PRIVATE DRUG PLAN
If you currently have private prescription coverage through employment, a family member, or because you pay for it yourself, your plan will most certainly cover at least a portion of the cost of PrEP. Your insurance plan determines how much you pay for medication and how much your insurance company pays.
SOURCE: Paying for PrEP. (2020, April 21). Ontario PrEP Clinics.
Ontario Drug Benefit
The Ontario Drug Benefit covers the cost of PrEP for Ontarians enrolled in Ontario Works, the Ontario Disability Support Program, home care, or community care programs.
Suppose you are enrolled in Ontario Works, the Ontario Disability Support Program, home care, or community care. In that case, you have coverage for a variety of medications, including PrEP, through the Ontario Drug Benefit program.
When you fill a prescription, show your OHIP card to the pharmacist and you will only have to pay up to $2 each time you fill a prescription.