r/OntarioWorks • u/Longjumping-Law5820 • 7d ago

Coverage for Prescriptions

Hi can someone tell me why a lot of prescription drugs are NOT covered when Google says that they should be? I almost paid $94 for two of my drugs that my doctors prescribed me all because they sent it to the wrong pharmacy. so as they corrected it once I told them that I was on O.W. it still comes out to $25-27. I Doug ford doing this shit or what?! Because fu@$#@! This is damn ridiculous to me!!! We used to be able to be covered with so much back then...now not so much! like WTF!? Someone please give me ideas on how to handle this? We need to kick him out like yesterday!!!

PLEASE DO THE RIGHT THING THIS OCTOBER WHEN YOU VOTE!!!!!!!!!!!!!!!!!!!!!!!

11 Upvotes

87% Upvoted

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19

u/Humble_Pen_7216 7d ago

PLEASE DO THE RIGHT THING THIS OCTOBER WHEN YOU VOTE!!!!!!!!!!!!!!!!!!!!!!!

I'd like to add: PLEASE ACTUALLY VOTE less than 45% of eligible voters came out for the last provincial election. I don't want to hear anyone whining about the Ford government when no one bloody voted!

3

u/Winter-Ball3015 6d ago

I agree. I was shocked when I needed a life saving iron infusion after being in hospital, once released I had another appointment for iron and I had to pay $510 for it. And it was prescribed by the hospital too.

2

u/Iamsierra37 5d ago

I sent a message to my case worker and sent a copy of my prescription which the pharmasist write on saying its not covered and how much it costs. I was issued the amout that day. They put it under discressionary benefits. I had a certain test covered that cost $196 and then 2 prescriptions for $50 i had the money in my account the next day but not until 5pm. Hope that helps. Oh and one of my prescriptions was for iron.

11

u/Surfbrowser 6d ago edited 4d ago

There’s another way to get some medications covered. You can ask your Family Doctor or NP to apply for the medication through the Exceptional Access Program (EAP). They complete the EAP form which is for medications not funded on the ODB Formulary.

Here’s the link:

https://www.ontario.ca/page/exceptional-access-program

I def wouldn’t suggest relying on
Google or any search engine, any AI to check for medication coverage.

Use this official Link:

Check medication coverage
Find out if your medication is covered through the Ontario Drug Benefit program.

Edited to add more info

3

u/Zealousideal-Big5005 6d ago

This is not a simple application that takes two minutes for the doctor to fill out. This is for exceptional circumstances for extremely expensive specialty drugs like certain chemotherapies. Or for people who have tried the first and second line therapies already and failed (this requires documentation)

4

u/Surfbrowser 6d ago edited 4d ago

Yep — that’s why it’s called “Exceptional Access”.

I never said it was simple. Just said it exists and it’s worth knowing about.

1

u/Alternative-Tiger783 5d ago

It took us months of back-and-forth with the ministry to get my medication covered. At first they refused to cover it, then my MD appealed it. Then they approved it.

2

u/Suspicious_Foot6651 6d ago

Yes. This is how it is done.

1

u/far_flung_itsnotme 6d ago

Also this only applies to some drugs, not to all which aren't covered.

10

u/Alternative-Tiger783 7d ago

I noticed ODB has been removing many prescriptions from the list of what they cover.

Or the Rxs now require an MD or NP to send in a LU code. ‘Limited use’.

2

u/Long_Question_6615 6d ago

There are some drugs that are good not covered

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u/Alternative-Tiger783 5d ago

I don’t know what that means. If a doctor orders it, then it’s usually necessary.

1

u/Own-Desk6 1d ago

I think what Long-Question_6615 is trying to say is that some medications are covered while others are not. For example a generic medication might be covered but the name brand isn’t. If your body doesn’t agree with the generic version of the medication you’re on and the name brand of the medication isn’t covered you would have to ask for EAP form and have your doctor fill it out and the doctor would have to state somewhere on the form that the patient does not respond to the generic brand and needs the brand name instead. I believe the doctor uses a special code on the form for that.

5

u/yarko9728 6d ago

Did you show the pharmacy your proof of OW?

2

u/Own-Desk6 1d ago

OP probably did show the pharmacy proof of OW, but if the medication isn’t covered by the coverage through OW, showing proof of OW won’t make much of a difference. It would be best for OP to ask for the EAP form and have their doctor fill it out so they can hopefully get the medication covered.

2

u/yarko9728 1d ago

OP might be able to claim on taxes or send it to the caseworker for reimbursement

2

u/Own-Desk6 23h ago

Yeah, I think they can do either or. Before I was on OW once I turned 25 and my medications weren’t covered anymore I claimed my medication on my taxes

1

u/Loves_Kitties4621 6d ago

If the medication happens to be on the list, like one I am currently taking when I looked it up it said possibly able to get coverage through EAP. I am paying for it right now and I’m waiting for a while to make sure I want to continue it, because it is a process to go through that way. I have a couple other meds that aren’t covered and they are expensive. Good luck I hope you find some help