O.Reg. 201/96

Regulation - LGIC

ONTARIO DRUG BENEFIT ACT

Trillium Drug Program (TDP) households must incur an out-of-pocket deductible of approximately 4% of their annual income before they become eligible for public drug coverage through the Ontario Drug Benefit Program. However, for the current 2019/20 benefit year, the annual deductible is calculated based on a household's 2018 tax information. Any income changes in 2020 related to COVID-19, would not be reflected in the deductible amount until the next benefit year, which does not start until August 1st, 2020. Therefore, between May 1st and July 31st, some households would be paying out-of-pocket expenses that exceed 4% of their current 2020 income.

Currently, an in-year reassessment for the 2019/20 benefit year deductible is permitted, but only for households who experienced significant income changes during 2019, not during 2020.

The MOH proposes to extend the in-year reassessment to include significant income changes that occur in the latter half of the TDP benefit year. This would allow households to use their 2020 income information for the determination of their deductible in the current 2019/20 benefit year (from May 1st until July 31st, 2020) if it is 10% or more different than their 2018 income.

Costs: The proposed regulatory changes pose no costs to businesses or the public. The proposed regulatory amendments would not result in additional administrative costs to business.

The estimated impact to government for FY2020/21 Q1/Q2 would be less than $4M, assuming 20-50% of existing TDP households (143,833 for FY 2018/19) will experience income decreases of 10-20%, resulting in an overpayment of TDP deductible of about $150-250 per household.

Data on the cost impact to TDP from new applicants is not available.

Benefits: Between 20-50% of existing TDP recipients would save on average $150 to $250 per household, which would be commensurate with income loss due to COVID-19 or any other factors.

20-HLTC016

May 1, 2020

May 2, 2020

n/a