Frequently Asked Questions About Prescription Drug Insurance

By Krista DeKuyper | July 3, 2024 | Individual Health

Prescription drug insurance plays a crucial role in ensuring individuals’ access to necessary medications. Understanding how prescription drug insurance works, what it covers, and how to navigate the process is essential for making informed decisions about healthcare coverage. In this blog post, we will address frequently asked questions about prescription drug insurance to help clarify common queries and provide valuable information to readers.

What is Prescription Drug Insurance and Why is it Important?

Prescription drug insurance is a part of the greater health and dental insurance category. Most health and dental policies will include prescription drugs, and you can customize how much coverage you would like. If you’re a relatively healthy person who uses minimal prescribed drugs, then you won’t need a lot of coverage. On the other hand, if you regularly take prescribed medicine for a condition like high blood pressure, you may want more coverage. Without prescription drug insurance, the out-of-pocket costs for medications can be prohibitively expensive, leading some individuals to forgo treatment due to cost concerns.

Are Brand-Name Drugs Better Than Generic Drugs?

No. At the end of the day, generic drugs are approved by Health Canada and must contain the same medicinal ingredients in the same quantities as the brand-name drugs. Generic drugs function similarly in the body and demonstrate equivalent safety and efficacy as their counterparts. However, this does not mean they are identical. Generic drugs may contain different non-medicinal ingredients compared to the brand-name version.

Ultimately, the decision lies with the individual. Brand-name drugs are marketed by the company that created them and are safeguarded by patents. On the other hand, generic drugs, which are typically more cost-effective, can only be manufactured once the patent for the original drug has expired.

Are Prescription Costs Tax-Deductible in Canada?

Prescription expenses are not deductible, but they are eligible for the Medical Expense Tax Credit, along with items like hearing aids, walkers, eyeglasses, service animals, and other medical necessities. To qualify for this credit, you can claim eligible medical expenses that exceed 3% of your net income or $2,479, whichever is lower. These expenses can be claimed for any 12-month period ending in the tax year being reported. Furthermore, one spouse has the option to claim the total medical expenses for the entire family, offering potential to enhance the credit amount eligible for deduction.

Does OHIP Cover Prescription Drug Costs?

Yes! The Ontario Drug Benefit program covers most of the cost of approximately 5,000 medications. You are eligible for this program if you are:

  • eligible for OHIP+
  • age 65 or older
  • living in a long-term care home or a home for special care
  • receiving professional home and community care services
  • enrolled in the Trillium Drug Program

Will My Prescription Cost The Same No Matter Which Pharmacy I Go To?

No. The price of the medication is determined by the pharmacy’s ability to provide a more affordable generic option instead of the brand-name version. Additionally, pharmacies apply a dispensing fee, the amount of which varies across different locations, presenting an opportunity to save money by exploring different options. Another cost-saving strategy is to request the maximum quantity that your pharmacy dispenses at once, typically a three-month supply. By doing so, you only incur a single dispensing fee, contributing to cost efficiency.

What Types of Medications are Covered by Prescription Drug Insurance?

Prescription drug insurance typically covers a wide range of medications, including brand-name and generic drugs. Commonly covered medications include those prescribed for chronic conditions, acute illnesses, and preventive care. Specialty medications, such as those used to treat rare diseases or complex conditions, may also be covered by prescription drug insurance, although coverage for these medications can vary.

What Do I Do With Leftover Medication? Can I Take It Back For A Refund?

Most drugstores do not accept returns, even for unused medication. However, it is crucial not to let unused medication linger in your medicine cabinet. Improper use or accidental ingestion of medication can lead to severe harm, which is why proper disposal is essential. When you have expired or unused medications, consider taking them to any pharmacy for safe disposal. Avoid throwing them in the trash, flushing them down the toilet, or pouring them down the sink, as these methods pose environmental risks.

What to Do If Your Prescription Drug Insurance Claim is Denied?

If a prescription drug insurance claim is denied, individuals have the right to appeal the decision. The first step is to review the denial letter from the insurance provider to understand the reasons for the denial. Individuals can then gather relevant documentation, such as medical records or a letter of medical necessity from their healthcare provider, to support their appeal. It is important to follow the appeals process outlined by the insurance provider and provide any additional information requested to overturn the denial.


In conclusion, prescription drug insurance plays a vital role in providing access to necessary medications for individuals. By understanding how prescription drug insurance works, what it covers, and how to maximize its benefits, individuals can make informed decisions about their healthcare coverage. Addressing common misconceptions, choosing the right insurance plan, and knowing how to save money on prescription medications are essential aspects of navigating the prescription drug insurance landscape. By being informed and proactive, individuals can ensure that they receive the medications they need at an affordable cost.

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