Steps to follow when you are using both PRIVATE/ WORKPLACE INSURANCE with a direct-pay card and TRILLIUM DRUG PROGRAM (TDP) combined:
Fill the prescription at the pharmacy, using your electronic card from the insurance company. Make a Xerox copy of the original receipt for your out-of-pocket expense. It is usually 10% or 20% of the cost of the drugs. Keep this copy for your records. Note that this receipt contains the name of the medication(s) and the costs. It is not the cash or credit card receipt. TDP does not need the cash or credit card receipt. Put your name and OHIP number or TDP registration (RA) number on each piece of paper or document that you send to TDP.
Send the original receipt to the Trillium Drug Program. TDP will credit your expense towards the deductible. They will reimburse you any amount that exceeds your quarterly deductible. Make sure that the physician on the receipt is registered under Facilitated Access if the drug is in that category.
Even though you have private insurance, TDP fully covers your medications after you reach your deductible in any given quarter. If you submit your claims quickly, chances are the pharmacy computer will register this prior to your subsequent refills within that quarter. If there is a delay, you will likely need to use the private insurance later in the quarter, until TDP revises the computer system information after they process your claims.
Note: Reimbursement from Trillium Drug Program usually takes some time. Whether you accumulate your receipts and send them in batches to TDP, or whether you send them each time you fill medications depends on your financial situation. It also depends on your desire to reach your deductible sooner in a given quarter in order to have TDP cover the costs. If possible, try to create a financial ‘cushion’ for yourself before you begin these reimbursement procedures.
Following is a sample letter a sample letter for submitting your receipts to TDP:
Date: day: month: year: _______
Trillium Drug Program,
P.O. Box 337 Station D
Etobicoke, Ont. M9A 4X3
Dear TDP staff:
Please find enclosed my latest receipt(s) for the ‘out-of-pocket portion’ that I paid for my medications.
Thank you for your assistance.
Signature:______________________________________ RA# ____________________
Print name _____________________________________ or OHIP# ____________________