paying_by_checkThe price of medications can lead to financial hardship. In most cases, assistance to cover prescription drug costs is available. The following information about drug cost assistance may be valuable. It can help offset expenses. It can help you afford the medications. It is important that you take HIV medications at regular times. You need to avoid missed doses.

Before you start drug treatment, make sure you have payment assistance. This will help prevent interruption of your drug therapy. Some of the ways to get assistance are complex. You might benefit from assistance from a professional with experience in this area. Your Social Worker, Physician, Nurse, or staff in many social service agencies including AIDS Service Organizations can often help you set this up. Note that you must usually pay a non-waived pharmacy dispensing fee for each drug.

For patients in Ontario, various sources cover HIV/AIDS drug costs. The first three systems are the most utilized. They are drug coverage mechanisms that many people know about. They are likely the ones you need to understand and pay attention to. The other systems are less common. It most cases involving these additional six systems, a professional involved in your care will know it is needed and will set it up with you.

Each system has rules. We describe the rules in this guide. Eligibility criteria may vary. It depends on individual circumstances. It depends on the drug coverage system used. It depends on the treatment medications.

Click below to review each section.

  1. Private insurance Plans (e.g., group plan at your place of employment)
  2. Ontario Drug Benefit Program (various pathways to drug coverage)
    • Social Assistance (Ontario Works; Ontario Disability Support Program)
    • Seniors’ coverage
    • Community Care Access Centre coverage
    • Trillium Drug Program
  3. Interim Federal Health (operated by CIC & Funds Administrative Services)
  4. Other Systems Ontario Drug Distribution and Monitoring Program (ODDMP)
    • Special Access Program, Health Canada
    • Department of Public Health
    • Workplace Safety Insurance Board
    • Patient Assistance Programs (operated by drug manufacturers)
    • Post-exposure prophylaxis (PEP) procedures

Appendix 1. Guidelines for insurance pay-direct cards & Trillium Drug Program combined

Appendix 2. Guidelines for manual insurance claims & Trillium Drug Program combined