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The Trillium Drug Program is a Provincial Government program for residents of Ontario who spend a large part of their income on prescription medications. Once you have spent a certain percentage of your income on medications, the Trillium Drug Program will cover, for free, the full cost of most medications until the end of the program year.

While many people with HIV are intimidated by speaking about their problem, it is important to remember that in order to get answers, you have to ask questions. If you have questions that aren't answered below, it would be a good idea to contact Trillium, using the contact information we give at the end of this chapter.

The Trillium Drug Program helps people who have high drug costs in relation to their net household income. Once an application is approved, the program covers :

over 3,100 prescription drug products;
over 300 limited-use drug products;
some nutritional and diabetic testing products.

you have no drug coverage, or your private insurance does not cover 100% of your prescription drug costs; if you have partial Insurance coverage, the TDP will cover the difference between the full cost of the medication and your insurance coverage.
you have valid Ontario Health Insurance (OHIP), and you are not eligible for drug coverage under the Ontario Drug Benefit (ODB) Program. You can't be receiving Ontario Works (OW) or Ontario Disability Support Program (ODSP) and also be covered by Trillium.

When you're accepted to Trillium, show your Ontario Health Card at your pharmacy to receive your prescriptions. Pharmacists will be able to keep track of all your medication purchases through the provincial Health Network computer system. Therefore, you will be able to purchase or receive your medications anywhere in Ontario. The pharmacist will also be able to tell you whether you have to pay.

When you apply for Trillium, you must submit proof of income. Trillium will calculate approximately 4% of your net income as your "deductible". That is, once you have paid that amount (4%) for medications, then Trillium will pay for the rest of your medication costs for the rest of the year. The Trillium fiscal year is from August 1st to July 31st. You pay your deductible in quarterly installments. Every 3 months, you will pay ¼ of your deductible towards your medication costs. Trillium pays the rest once you have paid or met your full quarterly deductible. The quarterly dates start August 1st, November 1st, February 1st, and May 1st.

For example, say your taxable income was $20,000.00 last year, and your medications are costing $500/month. Trillium would calculate that 4% of $20,000 = $800.00. That is the amount you would have to pay for the whole year between August 1st and July 31st.

The first time you go to your pharmacy, you have to pay ¼ of your $800.00 yearly deductible = $200.00 So you pay $200.00 of your drug cost, and Trillium pays the rest of the $300.00 for that month (since the medications were $500). Next month, you pay nothing, and Trillium pays for your medications. The same happens the next month. The month after that is a new quarter. You have to pay another ¼ of your $800 yearly deductible = $200.00, and Trillium pays for the rest.

If you do not reach your full deductible amount in a quarterly period, the unpaid amount is added onto your next quarter. You are still paying the same amount in the year, whether or not you pay it in every quarter. If you go through the whole year and had low drug costs and never paid your whole deductible, it doesn't carry over into the next year.

If you pay money out of pocket for prescription medicines before your Trillium application has been registered, save your receipts. You can be reimbursed or have the amount applied to your deductible.

Some pharmacies charge a $2 co-payment fee to fill each prescription, some do not charge. You may want to find a pharmacy in your community that doesn't charge the $2 fee on every prescription.

Trillium Drug Program application forms are available at pharmacies, clinics, some doctor offices and community agencies. You will be required to submit the most recent income information (previously mentioned) for all household members over the age of 16 who you wish to be covered by Trillium.

Applicants must be residents of Ontario, and have a valid Ontario Health Card. The program is available for single people, couples and families. You will be required to provide:

Income verification for all family members
Original receipts for medications purchased during the program year
Verification of insurance plans you may have that cover only part of the costs of your medications

Seniors need not apply to the Trillium Program - they can access Drug Benefits coverage through the Ontario Drug Benefit program for seniors.

Only certain drug costs count towards your Trillium deductible or as program benefits. Check with your pharmacist or health care provider to make sure your prescriptions are:

listed in the ODB Formulary/Comparative Drug Index (Parts III and IX);
on the Facilitated Access List of HIV/AIDS drugs (Part VI).

Requests for non-ODB drugs must be pre-approved by the ministry before the costs can count towards the Trillium deductible, or as program benefits. Your Doctor can help with this. It is always wise to let your Doctor know that Trillium is your source for medication coverage.

If you have partial Insurance coverage, the TDP will cover the difference between the full cost of the medication and your insurance coverage. When you buy medications, you must receive reimbursement from your insurance company first, and submit to Trillium the original statements from the insurance company and copies of the receipts from the pharmacy. Trillium will count the amount not covered by your insurance company as your costs, and these will count toward your deductible. Once Trillium receives all the information, they will process your receipts. If you have exceeded your deductible amount, Trillium will reimburse you the difference. Once Trillium has verified you have met your deductible, you can obtain medications for free at the pharmacy by just showing your Health Card, for the remainder of that quarter.

You can apply for Trillium at any time during the year. It can take anywhere from 2 to 4 weeks for your registration to be completed. Once you are registered with Trillium, you will receive a renewal notice prior to the start of the next Trillium year.

On your first year of application, you will be able to pick a start date for coverage to commence on. This pro-rated year means that your deductible will also be pro-rated. For example, if you pick coverage to start November 1st, your deductible will be pro-rated to 75% of the full amount, and divided over the remaining three-quarters. Medications purchased outside of this pro-rated period will not count toward your deductible.

When you submit your Trillium application, you will need to provide proof of last year's income with a Canada Customs and Revenue Agency (CCRA) Notice of Assessment for every family member to be covered over the age of 16. If you are unable to provide a CCRA Notice of Assessment, the TDP will accept a signed copy of your income tax, or T4 slips or letters from your employer confirming your income.

Limited Use Form
The medications covered under the Trillium Drug Program are medications listed in the Ontario Drug Benefits Formulary. Some medications are on the Formulary, but require additional forms to be completed by your physician in order for these medications to count toward your deductible. This is called a Limited Use Form, as prescribing certain medications is limited to certain physicians for patients in limited conditions. Without the Limited Use Form, these medications will not count toward your deductible. The Limited Use Form is good for one year from the date it is signed by the physician (a Limited Use Form can be back dated). Your physician will have the necessary Limited Use forms.

Section 8 Request
Some medications are not listed in the Ontario Drug Benefits Formulary, but are covered for individuals with unique needs. Your doctor must submit a special request to the Ministry of Health detailing your unique need. This is a Section 8 request, and if the Ministry approves coverage, the costs of these medications will count toward your deductible amount. Section 8 approvals are normally good for a 6-month period (and cannot be back dated). Your physician or Pharmacist can give you more details about both the Limited Use and Section 8 programs.

Reimbursement
Original receipts must be submitted to Trillium. Copies of medication receipts or computer print-out/patient profiles will not be accepted as proof of medication purchases.

If you start getting drug coverage from another source, you should let Trillium know. However, many drug plans have only partial coverage. You should then keep Trillium to cover the rest.

You pay the pharmacist until you meet your deductible. If you paid more than your deductible, you can submit your receipts to Trillium for reimbursement or to have the amount applied towards your deductible. If your income increases, you do not have to advise Trillium. They only ask income information once a year.

Q: Will my spouse/partner's drug insurance from their employer effect my Trillium application?
You must declare any drug insurance plans which cover you and all family members.

Q: I get drug insurance at my job. But it's a small company and my HIV drugs are going to cost a lot, and will effect everyone's premiums. I worry that people will end up figuring out that it's because of me. Can't I just go on Trillium and not use my employers drug insurance?
This is a very tricky situation. You could tell your employer that you wish to opt out of the drug insurance plan at work. Sometimes drug insurance is part of a benefits package that is not divisible, so you'd have to give up other benefits as well. You'll have to consider what's the best deal for yourself and your family. If you would be eligible for drug coverage under your spouse, common-law, or same-sex partner, you must declare that on your application.

Q: My income tax information for last year shows a much higher income than I have now. Will Trillium base my deductible on that amount?
You can request that your deductible be based on your current income. You will have to submit proof of your current income, such as pay stubs, a letter from an employer, a monthly pension statement, etc.

Q: Does my Trillium cover my child?
Your Trillium coverage will include all dependent children you declare on your application. For adult children living at home, speak with a Trillium representative.

Q: Do I have to renew Trillium every year?
Yes. Trillium will send you a renewal form. It is important to complete the form and submit it, as soon as possible, with proof of income to ensure you are re-enrolled for the new year.

Should you have further questions about the Trillium Drug Program, you can reach them at 1-800-575-5386 or in Toronto at 326-1558. Information is available through the internet at www.gov.on.ca, and go to the Ministry of Health section, or use your local Member of Provincial Parliament (MPP) as a resource.

We hope this information provided by the Ontario AIDS Network answers all your questions. If the section does not answer all your questions, and you have HIV/AIDS or are an individual or organization supporting someone living with HIV/AIDS, let our Benefits Expert answer your question. All responses are confidential. Click HERE to send your question.