Working out Drug Costs

How much will you pay for your medication?

This depends on a number of factors of course:

  • Should you apply for trillium? If you are working and have no drug plan then maybe you should.
  • Do you have a private drug plan? Even these are variable in terms of co-pay, drugs covered etc
  • How old are you?

If you have a drug plan you should call them with the Drug Identification Number (DIN) and check the situation

 

Are all pharmacies the same?

Absolutely not. There are significant differences between pharmacies in drug cost and dispensing fees. As an example, in March 2015 we visited three pharmacies to ask their prices for a month’s supply of some medication:We concluded that you should be aware that there is always the option of shopping around to get the best price for your medications

 

Apologies for the aoearance of the table – it depends on your browser or phone

Pharmacy                                             Costco             Freshco Pharmacy        Shoppers Drug Mart

Dispensing Fee                                    $3.89                            $8.83                           $11.99

Naproxen 500mg (twice daily)          $18.43                             $23.64                        $30.70

Methotrexate 20 mg (s/c weekly)      $23.37                            $33.95                         $23.22

Leflunomide 20 mg (daily)                 $89.53                            $96.06                        $126.10

Sulfasalazine 1g (twice daily)            $27.27                             $25.53                       $37.69

 

 

 

 

Tell me more about Trillium.

You should look this up – there is a lot of information on line. Provided you are able to navigate this (not always easy) you will get a sense of how it works, but to make things a little clearer here are some examples which (we believe) are correct as of April 2015.

 

Scenarios:

  1. 1.       Single Male age 24, income $16,000
    1. Drug Costs $1,200 per year
    2. Drug Costs $20,000 per year

 

  1. 2.       Common Law/Married Couple:

i.      Income:

  1. Person A: $16,000
  2. Person B: $16,000
  3. Drug costs $1,200 per year
  4. Drug costs $20,000 per year

 

  1. 3.       Common Law/Married Couple with 18 year old son,

i.      Income:

  1. Person A: $16,000
  2. Person B: $16,000
  3. Son:  $10,000
  4. Drug costs $1,200 per year
  5. Drug costs $20,000 per year

 

  1. 4.       Common Law/Married Couple with 18 year old son,

i.      Income:

  1. Person A: $16,000
  2. Person B: $16,000
  3. Son:  $10,000
  4. Drug costs $1,200 per year
  5. Drug costs $20,000 per year

 

 

 

Scenarios:

  1. 1.       Single Male age 24, income $16,000
    1. Drug Costs $1,200 per year
    2. Drug Costs $20,000 per year

Answer:   Pays  2.8% of Household income = $ 461 = $115.25 every 3 months.

  1. Drug Costs $1,200 per year: Pays $461 per year plus $2 for each prescription that the ODB program covers.
  2. Drug Costs $20,000 per year: Pays $461 per year plus $2 for each prescription that the ODB program covers.

 

  1. 2.       Common Law/Married Couple:

i.      Income:

  1. Person A: $16,000
  2. Person B: $16,000
  3. Drug costs $1,200 per year
  4. Drug costs $20,000 per year

Answer:   Pays  2.97% of Household income ($32,000) = $ 951 = $237 ever 3 months.

  1. Drug Costs $1,200 per year: Pays $951 per year plus $2 for each prescription that the ODB program covers.
  2. Drug Costs $20,000 per year: Pays $951 per year plus $2 for each prescription that the ODB program covers.

 

  1. 3.       Common Law/Married Couple with 18 year old son,

i.      Income:

  1. Person A: $16,000
  2. Person B: $16,000
  3. Son:  $10,000
  4. Drug costs $1,200 per year
  5. Drug costs $20,000 per year

Answer:   Pays 3.16% of Household income 42,000 = $ 1329 = $332.25 every  3 months.

  1. Drug Costs $1,200 per year: Pays $1,200 per year
  2. Drug Costs $20,000 per year: Pays $1,329 per year plus $2 for each prescription that the ODB program covers.

 

The only exception to including a Family Member as part of an application is if a household member is financially independent of the household. Financial independence means that the household member is self supporting, pays market-value rent, and their own living expenses. They cannot rely on family members for financial support. Likewise, family members cannot rely on this person for financial support.

 

  1. 4.       Common Law/Married Couple with 18 year old son,

i.      Income:

  1. Person A: $60,000
  2. Person B: $60,000
  3. Son:  $10,000
  4. Drug costs $1,200 per year
  5. Drug costs $20,000 per year

 

Answer:  Household income $130,000

i.      Deductable Calculation:

  1. Subtract $20,000 from Household income= $130,000-$20,000=$110,000
  2. Multiply the rest by 0.045 = (110,000*4.5%)= $4,950
  3. Add $500 to result = $5,450
  4. Subtract $150 for a household of three = $5,300
  5. Deductable = $5,300 per year, $1,325 every 3 months.

 

  1. Drug Costs $1,200 per year: Pays $1,200 per year
  2. Drug Costs $20,000 per year: Pays $5,300 per year plus $2 for each prescription that the ODB program covers.

 


 

To Qualify for Trillium Drug Program You Must:

  1. Live in Ontario
  2. Have a Valid Ontario Health Card

And

  1. Your household does not have a private insurance plan that covers prescription drugs, or your private insurance plan does not cover all the costs of your household’s prescription drugs.

And You are not covered by under ODB as:

  1. A senior over 65 years of age
  2. Someone who receives financial help through Ontario Work or the Ontario Disability Support Program
  3. A resident of a long term care home or home for special care
  4. Someone who receives home care services.

What drugs are covered by Trillium:

  1. Prescription Drugs Listed on the Ontario Drug Benefit Formularly