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 Post subject: ONTARIO drug benefit
PostPosted: Wed Aug 28, 2013 12:09 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
We have a drug benefit through dh's work. It is based on the Ontario Drug Formulary. If a drug is covered under the formulary, our plan covers it at 90%. If it is not covered under the formulary, our plan covers it at 50%. Currently, DH takes two prescription which are over $100 each, and we have to pay 50%. I just checked the formulary, and it says they DO cover it, so our plan should cover 90%. clear so far?

So, DH contacted the admin., and she said our plan is based on the ODB seniors plan. Well, I searched seniors ODB, and it links to the regular formulary.

Does anyone know if there is a different formulary for seniors in Ontario? This is specifically regarding prescription drugs (I think there's some differences for things like nn-prescription supplies).

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self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings


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 Post subject: Re: ONTARIO drug benefit
PostPosted: Fri Aug 30, 2013 11:40 am 
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Site Admin

Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6429
Location: Ottawa
Check out the Ontario Drug Benefit (ODB) Program. Seniors are eligible after they turn 65.
http://www.health.gov.on.ca/en/public/p ... b/odb.aspx

If the drug is not on the formulary (such as Epipen), there is a form for the Doctor to fill out. I know this applies for coverage under the Trillium program, not sure about private insurance programs...

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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 Post subject: Re: ONTARIO drug benefit
PostPosted: Fri Aug 30, 2013 11:56 am 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
Filling out the form is not allowed. We are covered under a company policy which is based on that formulary, not the actual government policy.

But here's the thing....she says drug --- is not covered because it's a seniors plan and seniors don't take that drug. But then, drug YYY is not covered because it's designed for people over 65. :banghead

So fed up with the massive cuts to the insurance policies. The yearly max for dental has not been raised in over ten years. One cleaning, one set of x-rays, and there was only enough left to remove two wisdom teeth.

_________________
self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings


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 Post subject: Re: ONTARIO drug benefit
PostPosted: Fri Aug 30, 2013 12:28 pm 
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Site Admin

Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6429
Location: Ottawa
Ugh! You may wish to talk to an ombudsman... :freak

_________________
Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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 Profile  
 
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