Upcoming drug benefit changes for Ontario Seniors including the Shingles Vaccine

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 1^st

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 1^st, 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 1^st, 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 1^st 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.