TRILLIUM & ODB COVERAGE FOR PrEP

 

PrEP is now covered by the Ontario Drug Benefit program, which includes OHIP+ and Trillium.

Here's practical information on what this means for you, and how to get PrEP if you need help paying for it and don't have an insurance plan. This section also gives you important information on ordering 3-month supplies of PrEP if you are on Trillium, managing deductibles and more.

If you have questions or need help getting started, please contact us at The Village Pharmacy.

 

PrEP is Free under OHIP+ and Ontario Drug Benefit (ODB) 

PrEP is free if you are 24 years old or younger, under the OHIP+ program. You must have a valid Ontario Health Card. Under OHIP+, you do not pay any deductibles or dispensing fees. 100% of the cost of PrEP is covered.

PrEP is free* under the Ontario Drug Benefit program for the following people:**

*Some pharmacies may require you to pay a small co-pay for your prescriptions. At The Village Pharmacy, we waive the $2 co-pay for all ODB recipients.

**You must be a resident of Ontario with a valid Ontario Health Card to be eligible for Ontario Drug Benefit.

***You may be required to pay a small deductible based on your income as a senior.


Get help paying for PrEP with the Trillium Drug Program

If you need help paying for PrEP and you don't have insurance coverage, the Trillium Drug Program can subsidize your costs for PrEP.

Getting Trillium coverage does not mean that PrEP is free.

If you qualify for the Trillium Drug Program, you will be required to pay a deductible (based on your household income) to help offset the costs of your medications.

Once you qualify, you and everyone in your household will be covered under the Trillium Drug Program. 

 

More about Trillium from the Government of Ontario

Government of Ontario - Trillium Drug Program

A Guide to Understanding the Trillium Drug Program (PDF)


How do I get my 3-month supply of PrEP on Trillium?

To guarantee that you will get your 3-month supply of PrEP if you are on Trillium, you must order your prescription at the beginning of each Trillium quarter. Here's how the Trillium year is split up:

  • Quarter 1: August 1 to October 31st

  • Quarter 2: November 1 to January 31st

  • Quarter 3: February 1 to April 30th

  • Quarter 4: May 1 to July 31st

Starting the middle of Quarter 3 and Quarter 4, Trillium starts to cut back the days supply that it will pay for. So, if you order your PrEP in March, you will only be eligible for a 2-month supply, NOT a 3-month supply.

So, if you want to ensure you get your 3-month supply throughout the year, order your prescription in August, November, February and May.  

When to order your PrEP for a 3-month supply:

  • August: order anytime this month for a 3-month supply
  • September: order anytime this month for a 3-month supply
  • October: order anytime this month for a 3-month supply
  • November: order anytime this month for a 3-month supply
  • December: order anytime this month for a 3-month supply
  • January: order anytime this month for a 3-month supply
  • February: order anytime this month for a 3-month supply
  • March: you may only receive a 2-month supply this month
  • April: you may only receive a 1-month supply this month
  • May: order anytime this month for a 3-month supply
  • June: you may only receive a 2-month supply this month
  • July: you may only receive a 1-month supply this month

If you have questions, please contact us at The Village Pharmacy, or get in touch with the Trillium Drug Program directly or call Trillium at 1-800-575-5386


How much will my Trillium Deductible be? 

The Trillium deductible is approximately 4% of your household income. The deductible is divided into 4 payments, payable on August 1st, November 1st, February 1st and May 1st of each year that you are on the program. 

In addition, a $2 co-pay is charged for each prescription you get from your pharmacy. The Village Pharmacy waives the $2 co-pay so you don't pay anything else out-of-pocket.

If you'd like the exact amount of your deductible, check out the Trillium Deductible Calculator on HIVNow.ca, use the chart at the end of the Trillium Guide, or use the formula below.

Trillium Deductible Formula:

  • Step 1: Start with your total household income and subtract $20,000
  • Step 2: Multiply your answer from Step 1 by 0.045
  • Step 3: Add $500 to your answer from Step 2
  • This result is your total annual deductible.

Trillium Quick Math - Is the deductible worth it for PrEP?

We've done a little bit of the math for you to help you decide if applying for Trillium coverage makes sense.

Because Trillium requires a deductible to be paid based on your income, you'd want this deductible to be less than the cost of PrEP if you paid for it out-of-pocket.

A household income of $75,000 is the level at which your Trillium deductible and the cost of PrEP are the same, at approximately $3,100 per year. 

If your household income is less than $75,000, your Trillium deductible will be lower than the cost of PrEP out-of-pocket, so you will save money.

If your household income is $75,000 or higher, there is no benefit to Trillium coverage if you are the only member of your household on PrEP, and you / other members of your household don't require coverage for other medications. 


Apply to get Trillium Drug Plan Coverage for PrEP

Everyone with a valid Ontario Health Card is eligible for the Trillium Drug Program.

You will need to have filed your income taxes by April 30th of each year.

If you haven't filed your taxes, get in touch with the Trillium Drug Program directly or call them at 1-800-575-5386. They'll ask you for more information and to provide proof of income.

To apply for Trillium coverage, you will need to download, print, complete by hand and then mail in the Trillium Application Form.  There is no online application process. 

Form completion tip: Sign in both sections where signatures are required: Declaration and Consent for CRA. If you do not sign the second section your application will not be approved. 

If you need help completing the form, get in touch with us at The Village Pharmacy - we'll guide you through the process. We also have paper copies of the form - you're welcome to come in anytime to pick one up.

Apply now to the Trillium Drug Program