Current as of October 2026. Government programs, tax rules and prices change. Check the official sources listed at the end of this page before making a decision, and confirm details with a licensed advisor.
What the Ontario Drug Benefit program is
The Ontario Drug Benefit program is the province's public prescription drug plan. It pays for most of the cost of medications listed on the ODB Formulary, which, as of October 2026, the Ontario government says includes more than 5,900 drug products, with other drugs considered case by case through the Exceptional Access Program. You fill the prescription at a regular pharmacy, show your Ontario health card, and the pharmacy bills the program directly.
For employers, ODB matters most in two places: employees who turn 65 while still working, and younger staff or family members who might otherwise qualify through OHIP+. Understanding both helps you set up a prescription drug benefit that fills real gaps rather than paying twice for the same thing.
Who qualifies for ODB
As of October 2026, the Ontario government lists these groups as eligible for ODB coverage:
- Seniors 65 and over: enrolment is automatic, starting the first day of the month after the 65th birthday. The province says it sends a letter about three months before that date.
- People 24 and under without private insurance: covered through OHIP+.
- People living in long-term care homes or Community Homes for Opportunity.
- People receiving professional home and community care services through Ontario Health atHome.
- People receiving Ontario Works or Ontario Disability Support Program (ODSP) benefits.
- People enrolled in the Trillium Drug Program, which helps households with high drug costs relative to income.
What seniors pay: the deductible and co-payment
ODB is not entirely free for most seniors. As of October 2026, a senior pays the first $100 of total prescription costs each program year (the deductible), then up to $6.11 for each prescription filled or refilled. The ODB program year runs from August 1 to July 31, so the deductible resets every August, not in January. In the first year of eligibility, the deductible is prorated based on birth month.
Lower-income seniors can apply to the Seniors Co-Payment Program. Approved seniors pay no deductible and up to $2 per prescription. For the 2026/27 program year (August 1, 2026 to July 31, 2027), the Ontario government set the income thresholds at $25,480 of annual net income for a single senior and $42,290 of combined annual net income for a couple. These figures were raised from the previous year ($25,000 and $41,500) to reflect cost of living increases, and the province says it reviews them annually, so they can change again. Seniors can apply online through the ODB program's forms website, or request a paper form by phone or email. To confirm income, the province can verify it with the CRA with the applicant's consent, or accept documents such as T4 or T5 slips, a Notice of Assessment, CPP or OAS statements, or an employer letter.
Other groups pay less: as of October 2026, people in long-term care, receiving home care, or on Ontario Works or ODSP pay up to $2 per prescription with no deductible, and those 24 and under in these groups pay nothing. Always confirm current amounts on ontario.ca before relying on them.
What ODB covers, and what it may not
ODB covers drugs listed on the provincial Formulary, subject to the program's rules. Drugs that are not listed may still be funded through the Exceptional Access Program when a prescriber submits a request and specific criteria are met.
That still leaves gaps that matter in everyday life. A newer medication may not be listed, the co-payments add up for someone filling several prescriptions a month, and ODB is a drug program only. It does not pay for dental work, glasses, hearing aids, massage, or physiotherapy at a private clinic. Some private plans cover drugs that ODB does not, which is one reason older employees often value keeping workplace coverage. The guide to what OHIP does not cover walks through the broader picture.
ODB and employer plans for employees 65 and over
Turning 65 does not mean an employee stops working, and many keep their group benefits. Once they become ODB-eligible, the employee has two potential sources of drug coverage: the provincial program and the workplace plan. How the two interact is set by the group contract, not by a single provincial rule, so practices differ from one plan to the next.
Common questions an advisor can help you work through include:
- Does the plan expect members 65 and over to use ODB first, and then reimburse the deductible, co-payments, or drugs that ODB does not list?
- Does drug coverage change, reduce, or end at 65 under the current contract, and do life or disability benefits change too?
- How should employees be told about the change, so a long-time team member is not surprised at the pharmacy counter?
- Would a health spending account be a simpler way to help with co-payments and the deductible?
Younger employees, dependants and OHIP+
OHIP+ is part of the ODB program, but it works differently. As of October 2026, the Ontario government describes OHIP+ as covering people 24 and under who are not covered by a private insurance plan. In practice, that means a young employee or a dependant child on your group plan generally looks to the workplace plan for prescriptions, while someone without private coverage can use OHIP+. If you are adding dependant coverage, the guide to dependant coverage explains what to consider.
Putting it together for your team
Public programs like ODB are a strong foundation, but they were not designed around your workforce. A thoughtful benefits plan looks at who you employ, their ages, their families and what they actually spend on prescriptions and care, then fills the gaps that matter. The guide to employee benefits after 65 covers the wider set of questions for older staff.
If you want help reviewing how your current plan handles employees turning 65, or you are designing a new plan, you can get matched with a licensed benefits advisor who works with Ontario employers. GroupBenefitPlans.ca is a referral service, so the advisor can explain options and the government program details that apply to your situation.
Common questions
When does Ontario Drug Benefit coverage start for seniors?
As of October 2026, coverage starts automatically on the first day of the month after a person turns 65. The Ontario government says it sends a letter about three months before that date.
How much does ODB cost a senior?
As of October 2026, most seniors pay a $100 annual deductible and up to $6.11 per prescription. Seniors who qualify for the Seniors Co-Payment Program pay no deductible and up to $2 per prescription. The program year runs August 1 to July 31.
What are the income limits for the Seniors Co-Payment Program?
For August 1, 2026 to July 31, 2027, the Ontario government set the limits at $25,480 of annual net income for a single senior and $42,290 of combined annual net income for a couple. Thresholds are updated over time, so check ontario.ca for the current year.
Can an employee 65 or older keep their workplace drug plan?
Often yes, but it depends on the group contract. Some plans change or reduce drug coverage at 65, and some coordinate with ODB. A licensed benefits advisor can explain what your contract says and the options available.
Does OHIP+ cover my employees' children if they are on our group plan?
As of October 2026, OHIP+ covers people 24 and under who are not covered by a private insurance plan. Children covered under a group plan generally use that plan for prescriptions.
Sources and further reading
GroupBenefitPlans.ca is a referral and information service. Advice and coverage are provided by the licensed professional and relevant providers. An enquiry does not activate insurance.