Your 2025 Guide to Diabetes Medication Coverage in Ontario
For individuals living with diabetes in Ontario, medication costs can be a significant concern. Whether you rely on insulin, GLP-1 medications like Ozempic, or oral glucose-lowering drugs, understanding your coverage options through OHIP vs. private insurance is essential to managing both your health and finances.
In this article, our team at Viva Health Pharmacy in Richmond Hill walks you through the differences between public and private insurance coverage for diabetic medications—and how you can get the most support based on your situation.
Quick Answer:
- OHIP does not directly cover medications—but you may qualify through the Ontario Drug Benefit (ODB) or Trillium Drug Program.
- Private insurance can often offer more flexibility, including coverage for non-essential or newer medicationslike Ozempic for weight loss.
- Each option has eligibility criteria, pros and cons.
Let’s break it down.
What Is OHIP and What Does It Cover?
The Ontario Health Insurance Plan (OHIP) covers many essential medical services, but not most prescription medications. Instead, drug coverage is provided through government programs connected to OHIP:
1. Ontario Drug Benefit (ODB)
ODB covers a wide range of prescription medications for:
- Seniors aged 65+
- Individuals on Ontario Works (OW) or ODSP
- Residents in long-term care homes
- People enrolled in the Trillium Drug Program
2. Trillium Drug Program
For people under 65 without private insurance or with high out-of-pocket drug costs, Trillium can help cover medications—including insulin, test strips, and oral diabetes medications.
💡 Learn more about Trillium here
What Diabetic Medications Are Covered by OHIP-Linked Programs?
✔️ Commonly Covered:
| Medication Type | Examples | Covered by ODB/Trillium? |
|---|---|---|
| Insulin | Humulin N, Novolin, Lantus, Basaglar | ✅ Yes (with or without LU codes) |
| Oral Medications | Metformin, Gliclazide, Sitagliptin | ✅ Yes |
| Test Strips & Supplies | LifeScan, Accu-Chek | ✅ Yes |
| GLP-1 Agonists | Ozempic (for diabetes only) | ✅ With LU code only |
❗ If Ozempic is prescribed only for weight loss, it’s not covered by public programs.
What Does Private Insurance Cover?
Private plans (Sun Life, Manulife, Green Shield, etc.) vary, but they usually offer:
✔️ Broader Coverage:
- Newer drugs (like Wegovy, Trulicity)
- Weight-loss use of Ozempic
- More frequent blood sugar testing supplies
- Flexible quantities and brands
✔️ Faster Access:
- No LU codes required
- No annual deductibles (in most plans)
- App-based claims and reimbursements
🔍 Always check your plan’s Drug Formulary to confirm specific coverage.
OHIP vs. Private Insurance – A Comparison
| Feature | OHIP/ODB/Trillium | Private Insurance |
|---|---|---|
| Coverage for insulin | ✅ Yes | ✅ Yes |
| Coverage for Ozempic (weight loss) | ❌ No | ✅ Often |
| Application complexity | Moderate (LU codes, forms) | Simple (depends on insurer) |
| Coverage for newest meds | ❌ Limited | ✅ Often available |
| Premiums | ❌ None (public) | ✅ Monthly fees may apply |
What If You Have Both?
Some people have both OHIP-linked coverage (e.g. ODB) and private insurance. In this case:
- ODB/Trillium is billed first.
- Private insurance covers any remaining balance (e.g. dispensing fee or partial coverage).
- If neither covers a specific medication, ask your doctor if there’s a formulary alternative.
Tips to Maximize Your Coverage
Here are ways to save money and simplify access to your medications:
- Apply for Trillium if your drug costs are high
- Ask your doctor to include LU codes on prescriptions
- Bring your insurance card to the pharmacy every time
- Use a Viva Health Medication Review session to explore options
- Ask about generic substitutions and manufacturer discount cards
Diabetes Medication Support at Viva Health Pharmacy
At Viva Health Pharmacy, we help you navigate both public and private systems:
- Personalized medication reviews
- Help with LU code documentation
- Communication with your insurer and doctor
- Free delivery in Richmond Hill and surrounding areas
- Support in English and Farsi
Useful Resources
- Trillium Drug Program – Ontario.ca
- ODB Formulary Search
- Diabetes Canada – Medications
- Health Canada Drug Database
Frequently Asked Questions
Q: Can I use private insurance to cover insulin if I’m also on Trillium?
Yes, Trillium is billed first. Private insurance can be used for any unpaid portions.
Q: What if my medication is not covered by either?
Ask your doctor or pharmacist about switching to a similar covered alternative.
Q: Can I claim medication costs on my taxes?
Yes, in many cases, out-of-pocket medication expenses can be claimed as medical expenses on your tax return.
Choosing between OHIP programs and private insurance depends on your medical needs, financial situation, and available benefits. For people living with diabetes, it’s essential to understand what options are available—so that you can get the medications you need, without breaking the bank.
Need help navigating your options?
We’re here to support you.
Contact Viva Health Pharmacy
📍 Location: 9580 Yonge St, Unit 5, Richmond Hill, ON
📞 Phone: (905) 237-5567
🌐 Website: www.vivahealthpharmacy.com
Helping you manage diabetes—with care, clarity, and community.
