Serious financial issues arise out of serious injuries. Difficulties with income, money management, cost of care, and cost of medication, go hand in hand with serious injury, and an inability to work. In many instances Siskinds LLP represents individuals who have been seriously injured in an accident. They are incapacitated, and need help to access all the benefits available to support them. The Ontario Trillium Drug Program is one such benefit.
Serious financial issues arise out of serious injuries. Difficulties with income, money management, cost of care, and cost of medication, go hand in hand with serious injury, and an inability to work. In many instances Siskinds LLP represents individuals who have been seriously injured in an accident. They are incapacitated, and need help to access all the benefits available to support them. The Ontario Trillium Drug Program is one such benefit.
The Trillium Drug Program
The Ontario Trillium Drug Program is designed to assist a person on a fixed income cover the cost of prescription medication. It is an annual drug benefit, available to residents of Ontario who have a valid Ontario Health Card and who do not have a private insurance plan covering the cost of prescriptions.1
Although all holders of an Ontario Health Card are eligible for the benefit, in order to receive payment or repayment, the applicant must demonstrate that they spend in excess of 4% per year of the net income of their household, calculated annually, on prescription medication. The initial 4% of the net income spent on prescription drugs is the deductible, and is not reimbursed. Any amount spent in excess of 4% of the net income of a household, is eligible for reimbursement.2
Once entitlement is determined, the program will cover payment for prescription drug products listed on the Ontario Drug Benefit Formulary/Comparative Drug Index, which includes 3800 quality-assured prescription drug products, 450 limited-use drug products, and some nutritional and diabetic testing agents. Drugs not listed in the Index may still be funded with prior authorization through the Exceptional Access Program.3
In Practice
In cases of fixed income, and high medication expense, the Trillium Drug Benefit may help alleviate financial hardship. Siskinds LLP recently obtained Trillium Drug Benefits for a traumatically brain injured client. His case resolved and he received a structured settlement, putting him on a fixed income from which he has to pay for rent, groceries, and ongoing care. Although his case settled, his medical bills continued rising to the point they amounted to an approximately $14,000.00 annual expense. In this case, the Trillium Drug Program benefit helped to ease significant financial hardship for a seriously injured individual.
Steps to Obtaining Trillium Drug Program Benefits
To obtain benefits you must show that:
- You have a valid Ontario Health Card;
- You do not have a private insurance plan that covers the costs of prescription drugs; and,
- You are a member of a household that spends more than 4% of its net income on prescription drugs.
For the purposes of the Ontario Trillium Drug Program, a household can be defined as:
- A single person living along;
- An individual residing with a spouse, common-law spouse, or same-sex partner;
- A person living with children, parents, or grandparents who either rely on him or her for financial support or vice versa; and,
- Children who are students, who may not live with an individual but rely on him or her for financial support, such as students who are away for school or children living abroad.4
How to apply
- Complete the application form and submit the required supporting documentation. The application form can be found online5;
- Applications are due prior to September 30th of each year. This is a hard deadline, with no exemptions; and,
- Prescription receipts, insurance statements, proof of income and other documentation must be submitted by October 30th of each year.6
Knowing the potential benefits available to a personal injury client is crucial for advancing a complete and comprehensive case for compensation in a claim for personal injury. If you have any questions regarding an injury, including brain injury, or would like more information about your legal rights, please contact Maciek Piekosz via email at [email protected] or call 519-660-7718 for a free consultation.
1 A Guide to Understanding the Trillium Drug Program, Ministry of Health and Long-Term Care (Form 014-546850E-87, Ed. 2013/12) at 3
2 A Guide to Understanding the Trillium Drug Program, Ministry of Health and Long-Term Care (Form 014-546850E-87, Ed. 2013/12) at 12
3 A Guide to Understanding the Trillium Drug Program, Ministry of Health and Long-Term Care (Form 014-546850E-87, Ed. 2013/12) at 3, 16-17
4 A Guide to Understanding the Trillium Drug Program, Ministry of Health and Long-Term Care (Form 014-546850E-87, Ed. 2013/12) at 4
5 http://www.forms.ssb.gov.on.ca/
6 A Guide to Understanding the Trillium Drug Program, Ministry of Health and Long-Term Care (Form 014-546850E-87, Ed. 2013/12) at 5, 15