Recently, we have been receiving lots of questions about the new
government funding for the shingles vaccines for Ontario seniors. In this
month’s blog, we will answer your question about the shingles vaccines and we
will explain how the announcement by the government on the upcoming changes to the
Ontario Drug Benefit program may affect you.
New government
funding for the Shingles Vaccines
The shingles vaccine (Zostavax II) is currently not covered under the
Ontario Drug Benefit. Seniors have to pay out of pocket to purchase this
vaccine and it costs approximately $200 for the one-time vaccination.
The
Ontario government aims to provide funding to cover the cost of this vaccine
for seniors, however, only seniors
between 65-70 years old will be eligible for this coverage. According to
the public health agency of Canada, the shingles vaccine is recommended for
persons aged 60 and older and may also be used in adults 50 years of age or
older. This means that some seniors will still have to pay out of pocket for
this vaccine after the new funding is in place. To purchase this vaccine, you
need a prescription from your doctor and it has to be administered at your
doctor’s office.
Custom Care
Pharmacy has the shingles vaccine in stock all year round.
Changes to the
eligibility for $2 co-payment of the Ontario Drug Benefit coverage for 65 years
and over
Before we explain the upcoming changes to the Ontario Drug Benefit
program, we will start by giving you some background information on this
program.
The Ontario Drug Benefit program is provided by the government of
Ontario to pay for the cost of some prescription medications for seniors that
are 65 years old and over. The medications that are covered under this program
are listed in the Ontario drug formulary and medications are added or removed
on an ongoing basis.
To find out if a medication is covered under the Ontario
Drug Benefit, you can go to the following webpage https://www.healthinfo.moh.gov.on.ca/formulary/ and enter in the
name of the medication to search the formulary. Otherwise, you can also ask our
pharmacist at Custom Care Pharmacy to check for you.
If your prescription medication is covered under the Ontario Drug
Benefit, the amount that the government requires you to pay for the
prescription medication will depend on your income that was stated in your
annual income tax submission.
For example:
If your income is less than $16,018 as a single senior or less than $24,175 as a
couple, then you are only required to pay $2 co-pay for each prescription. At
Custom Care Pharmacy, we waive the $2 co-pay.
If you income is more than $16,018 as a single senior or more than $24,175 as a
couple, then the government requires that you pay for the first $100 towards
your prescription costs. This is called an annual deductible and it begins
every year on August 1st. After the $100 deductible is completely paid, the
government requires that you pay only $6.11 for each prescription until the
next August 1st
At Custom Care
Pharmacy, we waive $2.11 for high income seniors so you only need to pay $4 per
prescription.
Changes to the
income thresholds to qualify for the low-income seniors’ benefit
Beginning August 1, 2016, single seniors with an income up to $19,300 or
$32,300 as a couple will qualify for the “low income” seniors’ benefit.
Low-income seniors, under the coverage of Ontario Drug Benefit, will pay only
up to $2 co-payment per prescription with no annual deductible. At Custom Care
Pharmacy, we will continue to waive the $2 co-pay.
This upcoming change means that seniors that were previously
considered “high income” and has to pay an annual deductible of $100 and $6.11
per prescription afterwards, may now be eligible for the “low-income” seniors’
benefit if their income is less than $19,300 for single or $32,300 as a couple.
However, if the seniors’ income is higher than the new thresholds, they
will have to pay $170 for the annual deductible beginning on August 1st,
2016, compared to the $100 annual deductible previously. Furthermore, the
co-payment portion that comes after the annual deductible is fulfilled, has increased from $6.11 to
$7.11. This will also take effect on August 1st, 2016.
The annual deductible will not be collected all at once. Each time you
fill a prescription, the cost of the prescription is added towards the
deductible until $170 is fulfilled. After that, you will only need to pay $7.11
for each prescription that is covered under the Ontario Drug Benefit,
regardless of how much the prescription cost.
Custom Care
Pharmacy will continue to waive $2.11 for high income seniors after August 1st
2016
No changes are proposed to public drug benefits through Social
Assistance, Long-Term Care Homes, Homes for Special Care, Home Care and the
Trillium Drug Program.
If
you still have any questions on how the upcoming changes may affect your drug benefit
coverage, please don’t hesitate to contact us at 905-305-0111. We will be happy
to help you.