The Ontario Ministry of Health and Long-Term Care announced it is modernizing the Trillium Drug Program (TDP) in the fall.
The Trillium Drug Program (TDP) is a provincial government program for residents of Ontario that have high drug costs in relation to their household income.
These changes will enhance the Health Network System (HNS) and supporting systems to allow for co-ordination of benefits (COB) between private insurance plan(s) and the TDP at the pharmacy once the initial claim has been adjudicated by the private plan(s).
How the New Process Will Work
Payments by the insured person towards the quarterly TDP deductible will be tracked in the HNS and once the deductible amount is met, the government payments would automatically kick in (minus a $2 copayment). There will no longer be the need to submit paper receipts to TDP during the pre-deducible stage which could save up to six weeks or more wait time in order to receive TDP benefits and reimbursement.
This automated process will rely on the insured person to provide all of their private plan information (group, individual, veteran etc.) to the pharmacist at time of purchase. It will also rely on the pharmacist to submit the claims to all plans in the proper order, up until the insured person has reached their deductible for the quarter.
After that, Trillium will become first payer, but only for Trillium drugs until the end of the quarter. After this, the pharmacist will revert back to the private plan(s) being first payer and Trillium being payer of last resort until the next quarterly deductible is met.
If you have a Health Care Spending Account
Patients with a Health Care Spending Account (HCSA) that includes drug coverage must use their entire HCSA allowance and meet their TDP quarterly deductible before they are eligible for TDP benefits.
There are no changes to TDP regulations themselves; the program itself remains the same.