Drug Coverage For Seniors

We recently received an email from a reader who was concerned about the high cost of prescription medication for seniors.  He was under the impression that after the age of 65 all prescription medication was covered by provincial health care.  I have to admit that I also thought this until my mother informed me that she was paying over $400 a month for her medications.

I looked into the various provincial plans and found that, for the most part, seniors do have complete or partial drug coverage.  All the provinces have very different plans.  Details for your province can be found here.

Drug Coverage For Seniors: A Brief Overview

Manitoba is the only province that doesn’t have a dedicated seniors’ program.  Their Pharmacare program is based entirely on income (regardless of age).  The deductible is based on income multiplied by 2.73% to 6.17% with a minimum of $100 per year.

Nunavut and Yukon seniors receive full drug coverage with health care paying the full cost of approved drugs (usually the lowest price generics).  Otherwise, Saskatchewan is the least expensive with people over 65 paying just $15 per prescription.

Alberta seniors pay 30% of prescriptions up to a maximum of $25 each.  AlbertaBlue Crossalso administers North West Territories’ drug care but the age is reduced to 60 years.

BC, Ontario, Newfoundland & Labrador, Nova Scotia and Quebec plans are based on income with most having a $100 deductible and coverage after up to 6.17% of income is paid.

Quebec, Nova Scotia seniors pay an annual premium of up to $563 (subject to income).

Ontario, Yukon and PEI all have residency requirements.  Applicants must be physically present for 6 months plus 1 day each year and the province must be the primary place of residence.

Interestingly, in Quebec everyone must be covered by prescription drug insurance, with either a private or public plan.

In Quebec and Newfoundland & Labrador seniors are automatically registered when they start to receive GIS and OAS benefits.  In all other provinces you have to apply for coverage.

With all plans:

  • Seniors must be enrolled in the Provincial Health Care plan
  • Drugs must be on the province’s approved drug list (can vary between provinces)
  • Payment is made only on the lowest price generic drug if a generic is available
  • Usually do not pay the dispensing fee

You could also check out the various private health care plans to compare costs and benefits.  For example, FlexCare drug plans are available through the Canada Protection Plan website.

Don’t stop once you’ve established a great plan, as there are more alternatives to save on your prescription drugs.  A few of these alternatives may seem more obvious than others.  Arguably the easiest way to save is to ask for generic drugs, as they can cost nearly a quarter of the price as their name brand counterparts.  Another money saving alternative is to order your prescription drugs online through Canada.  This method not only saves you money, but also a trip to the drug store. As always, speak with your doctor before making any drastic changes to your prescription.

Your best bet is to keep your employee benefits.  Most companies with health and drug benefits for employees extend them to retirees at considerable savings.  Make sure you actually retire and don’t just quit or you’ll lose them.

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  1. Gary on August 9, 2011 at 7:08 am

    Thank you so much for your post. We young seniors are going to have to be advocates for our elderly seniors. Keep up the good work — information is power!

  2. Boomer on August 11, 2011 at 5:08 pm

    Hi Gary. You’re right. My mom didn’t know she had to apply for senior’s drug coverage and had been paying full price for years. Now some of her medications are actually free.

  3. OBK on August 13, 2011 at 5:29 pm

    Hi – just wanted to provide some info for Ontario seniors:


    In Ontario, as long as you provide your health card number to your pharmacy once you turn 65, your coverage under the provincial plan will begin on the 1st of the month following your 65th birthday. So if you turn 65 on 3 March, your coverage under Ontario Drug Benefit (ODB) starts on 1 April.

    Most people think that turning 65 means all your prescriptions become free – unfortunately, this is not true as you have pointed out. Any drugs not on the province’s formulary are not covered and the patient must pay full price for them. Ontario also has co-payment requirements that vary depending on your income level (see details in linked article). In general, the Ontario government tends to slot everyone into the “high income senior” category, thus requiring them to pay an annual $100.00 deductible (payment of deductible begins August 1st each year), and once the deductible is satisfied, the patient pays a $6.11 copayment per prescription. Low income seniors do not have an annual deductible and start immediately paying a $2.00 copayment per prescription when covered by ODB. People can apply for the lower copayment option if they are not, in fact, in the high income bracket.

    I also wanted to clarify the difference between a dispensing fee and a copayment. Most people think what they pay at the till is the dispensing fee – it isn’t. The dispensing fee for the province is built into the price of the description and it is currently set by the Ontario government at $8.20. The dispensing fee for anyone covered under ODB is the same at every pharmacy in Ontario. What varies is your copayment amount, which is what you pay at the till, and there is a copayment for each prescription, not for all prescriptions (e.g. if you get three prescriptions, you pay either 3 x $6.11 or 3 x $2.00, not just $6.11 or $2.00 for all three prescriptions…not sure if that makes sense as written).

    It seems that the ODB program isn’t very well explained to patients and there are often misconceptions about how it all works. Hope this helps clear some things up for Ontario seniors.

    • Joachim Richter on December 6, 2016 at 2:31 pm

      After sometime in Thailand I returned to Canada again. Due to a serious Post-Traumatic Stress Disorder as a result of two parental abductions of my daughter, one international, I ended up on the Ontario Disability Support Program with no costs for medication. Medication in Thailand costs about 1/3 of Ontario.

      I am 70 years of age, had a heart attack with an emergency open heart operation and also survived two strokes, also permanent PTSD. Medication for me is important. Yet, I cannot pay for it anymore and now I am without any medication at all.

      Since I moved to Brampton on November 1, I am dealing with 2 pharmacies in Brampton, Ontario:

      1. Shoppers Drug Mart at the Bramelea City Centre Mall,
      2. the pharmacy on 25 Gateway. which recently charge me $49.25 for medication (South Asian owned)

      I also completed and sent off my health form for seniors to the Ontario Ministry of Health from my former address in Toronto early August 2016, but have never heard back from them until now. I moved to Brampton on November 1.

      Both pharmacies have never told me about senior drug benefits and just keep on charging the hell out of me.

      They have never told me about the $100 payment annually due in August. Only a third pharmacist in Toronto told me that I had paid $83 towards it by now and that $17 were still due. The two mentioned pharmacy state that they don’t know anything about payments I made.

      I believe that they fleece old age pensioners out of plain greed, which I find disgusting.

      I would seriously appreciate your advice to end the fleecing of elderly people by these two pharmacies.

  4. Boomer on August 21, 2011 at 2:23 pm

    @OBK Thanks for the information. It’s too bad that the governments make this so confusing. It’s no wonder seniors (or anyone else) can’t figure out how it works.
    It was my understanding that the dispensing fee is charged by the drug stores (their fee) and copayment is the amount you pay over and above what the plan pays. As well, some provinces charge a monthly or quarterly premium that may or may not be subsidized according to your income.

  5. Linda on November 4, 2013 at 10:36 am

    would someone tell me if ohip,drug plan + supplement the same in BC as in ont. Would like to know before I consider making the move to BC

  6. Lyn Thompson on November 29, 2014 at 2:42 am

    Hi, I lived in Ontario for 30years before moving to Victoria BC to be near to family. When I was in Ontario I received the “Ontario Drug Plan for Seniors” – it was great! I am diabetic and since retiring from a “hospital health care job” at age 60 years I was left to pay the full cost of my drugs which amounted to around $400.00 per month. I was very happy to just pay $100.00 per year and a dispensing fee on several medications. It brought down my expenses a great deal and I could finally enjoy the pension (not huge) that I had earned over 25+ years of working.
    Now I am in BC and I have to pay for my drugs all over again because I earn too much! Its really not nice! Its not like I have a “huge income” but rather one that gives me a monthly amount that I still budget on a weekly basis. However, I feel all my years of working and contributing has not helped me. Compared to some countries we pensioners seem to pay and get no relief on anything. If anyone knows something more than this please respond would love to hear – Thanks!

  7. seemin maqsood on July 21, 2016 at 10:02 am

    Hi I am a 60 year old retiree who has worked most of his life outside canada, and have been on non-resident status. Will i still be eligible for Ontario drug plan for Seniors once I move back to canada?

  8. boomer on July 21, 2016 at 4:17 pm

    @seemin maqsood: Eligibility for the Ontario seniors drug plan is income based and you have to be 65 years old. You must live in Ontario and have a valid Ontario health card for which you must be a Canadian citizen or permanent resident (or eligible newcomer). The plan normally becomes effective three months after the date you establish residency.
    Apply in person at a ServiceOntario Centre near you.

  9. Eileen Herbert on November 5, 2016 at 8:40 pm

    In October I went to visit a friend in Vancouver. On my first day there
    my friend who turns 71 this December said she had to pick up 4 refills.
    All common drugs that a senior would Take. Her bill was $104. I asked her if had a drug benefit plan . C replied yes and this is how much she pays. C still works 6hr 3 times a week to supplement her old age pension
    and she lives a very simple life. C asked what I pay and I said it was the first $100 and then $4.11 per refill or new prescription. I was considering
    relocating to BC for the better weather but now will have to reconsider.

  10. John on November 18, 2017 at 9:14 am

    I put in a prescription to shoppers drug mart,in Ontario which I usually pay 4.11 cents for, but this time I was told, you have to pay the full price as we sell it over the counter, is this correct??

    Thank You.

    • boomer on November 19, 2017 at 11:10 am

      Hi John: Ask your doctor. Sometimes you can get a generic version of an over-the-counter medication by prescription. Then, you’ll have to see if your drug plan covers it.

      • John on November 19, 2017 at 12:21 pm

        Thanks boomer, I never thought of that one.. I just thought, shoppers, are telling me, I have to buy over the counter and pay 24 dollars, but if you had given me it via prescription price it would only be 4 dollars eleven cents, so I was a bit surprised by it. Thanks boomer for your advice, Appreciated, All The Best.

  11. Dorothy Sittler on August 24, 2019 at 1:55 pm

    How do I know whether Shoppers has overstepped the 100CAD deductible that I have to pay? It seems like I have already paid and paid and paid since July 1st.

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