Ontario Budget 2012-Changes to Ontario’s Drug Benefit Program

The Ontario Drug Benefit (ODB) program helps seniors with the cost of their prescription drugs. Under the current ODB program, seniors pay the first $100 of their drug costs each year and a co-payment of $6.11 for each prescription after the $100 deductible amount. The $100 deductible is waived for lower-income seniors but they are required to pay an existing $2.00 co-payment for each prescription. All seniors are eligible for the ODB regardless of their income level.  Starting August 2014, high-income seniors will pay a new income-tested deductible.
The new deductible will increase gradually with net income:
  • For high-income single seniors with income over $100,000, the deductible
    amount will be $100 plus three per cent of income over $100,000
  • For high-income senior couples with a combined income of over $160,000, the
    new deductible for the couple will be $200 plus three per cent of their
    family income over $160,000
  • These seniors will also continue to pay a co-payment of $6.11 per prescription
    after the deductible amount
  • Income thresholds will not be indexed for inflation.
Examples of ODB Deductibles
No Change
Single Seniors
Net Income ($) 16,000 40,000 100,000 120,000 150,000 200,000
Deductible ($) 0 100 100 700 1,600 3,100
As % of income 0.00% 0.25% 0.10% 0.58% 1.07% 1.55%
Senior Couples
Net Income ($) 24,000 60,000 160,000 200,000 250,000 300,000
Deductible ($) 0 200 200 1,400 2,900 4,400
As % of income 0.00% 0.33% 0.13% 0.70% 1.16% 1.47%
These changes will not increase drug costs for seniors with net incomes below the $100,000 or $160,000 thresholds who already get drug benefits:
  • These seniors will continue to pay only the first $100 of their drug costs each
    year, plus a co-payment of $6.11 for each prescription after the $100 amount
  • The $100 deductible will continue to be waived for lower-income seniors.
    Lower-income seniors who currently pay the $2.00 co-payment will continue
    to pay $2.00 per prescription.
Next Steps
If this Budget passes a confidence vote, employers who provide drug coverage for employees over age 65 or retirees should review their plan to determine whether they may be responsible for these new higher deductibles, and, if they are, decide whether they want to amend the plan with proper notice to ensure employees/retirees pay their deductibles.