For thousands of Ontarians managing diabetes, medications are a daily necessity—and often a significant expense. The good news is that many key treatments are funded through OHIP-linked drug programs in Ontario.
As we enter 2025, it’s worth reviewing which diabetes medications are covered, how eligibility works, and how your local pharmacy in Richmond Hill can help you access them affordably.
Understanding OHIP and the Ontario Drug Benefit (ODB) Program
While OHIP (Ontario Health Insurance Plan) pays for doctor visits, lab tests, and hospital services, prescription drugs are covered through the Ontario Drug Benefit (ODB) system.
You automatically qualify for ODB coverage if you are:
- 65 years of age or older
- Receiving Ontario Works (OW) or Ontario Disability Support Program (ODSP) benefits
- Living in a long-term care or special care home
- Receiving professional home-care services
- Registered in the Trillium Drug Program (for households whose medication costs are high relative to income)
If you’re eligible, most essential diabetes drugs—including insulin and common oral agents—are funded either fully or partially.
1️⃣ Metformin – The First-Line Therapy
Metformin remains the cornerstone of Type 2 diabetes management in Canada.
It lowers blood-sugar levels by improving insulin sensitivity and reducing glucose production in the liver.
- Coverage: Metformin (generic form) is fully listed on the ODB Formulary as a General Benefit (GB) drug.
- Typical brands: Glucophage®, Glycon®, and multiple generic options.
- Cost to patients: Free or low-cost ($0 – $6.11 per prescription for seniors).
Because of its long-term safety record, Metformin is almost always the starting point for Type 2 diabetes treatment.
2️⃣ Insulin – Essential and Widely Funded
Insulin remains fully covered under the Ontario Drug Benefit Formulary for patients who qualify.
Common types included:
- Rapid-acting: Humalog®, NovoRapid®
- Short-acting: Humulin R®, Novolin Toronto®
- Intermediate & long-acting: Lantus®, Basaglar®, Levemir®, Toujeo®
- Premixed insulins: Humalog Mix 25/50®, Novolin 30/70®
Coverage applies to both Type 1 and Type 2 diabetes patients who require insulin, and includes most vials, cartridges, and disposable pens.
Your pharmacist in Richmond Hill can check which brand your plan covers and suggest cost-effective biosimilar options if needed.
3️⃣ Ozempic (semaglutide) – For Type 2 Diabetes with Cardiovascular Risk
Ozempic is one of the most sought-after GLP-1 receptor agonists in Canada.
It helps lower blood-sugar levels, promotes weight loss, and reduces heart-related risk.
- Coverage status (2025): Listed as a Limited Use (LU) product on the ODB Formulary.
- Who qualifies: Patients with Type 2 diabetes whose blood sugar is not controlled with Metformin and who have cardiovascular risk factors.
- How coverage works: Your doctor must include the LU code on the prescription.
- Weight-loss use: Not covered under OHIP if prescribed solely for weight management.
Private insurance or the Trillium Drug Program can help offset costs if you don’t meet the LU criteria.
4️⃣ Jardiance (empagliflozin) and Other SGLT2 Inhibitors
SGLT2 inhibitors are newer oral medications that help the body remove excess glucose through urine and reduce heart failure risk.
Covered options under ODB in 2025 include:
- Jardiance (empagliflozin)
- Forxiga (dapagliflozin)
- Steglatro (ertugliflozin)
These drugs are listed as Limited Use (LU) products — coverage applies for patients with Type 2 diabetes whose blood sugar remains high despite first-line therapy and who have heart disease or renal concerns.
Your doctor must note the LU code and document eligibility criteria.
5️⃣ DPP-4 Inhibitors – A Flexible Option for Combination Therapy
DPP-4 inhibitors such as Januvia (sitagliptin), Onglyza (saxagliptin), and Trajenta (linagliptin) work by increasing insulin release after meals and reducing glucose production in the liver.
- Coverage status: Most DPP-4 inhibitors are covered as Limited Use under ODB for patients who cannot achieve target A1C levels with Metformin or sulfonylureas.
- Advantages: Taken orally once daily and generally well-tolerated.
These are often combined with Metformin to enhance control without causing hypoglycemia.
Bonus: Combination Medications
Ontario’s Formulary also covers several combination pills that reduce the number of daily doses and improve compliance — for example:
- Janumet® (Metformin + Sitagliptin)
- Synjardy® (Metformin + Empagliflozin)
These are also Limited Use benefits and require proper prescription coding.
How to Check Your Eligibility in 2025
- Confirm ODB or Trillium enrollment. Ask your pharmacist if you’re registered under the program.
- Review your current plan. Bring your insurance card and any Trillium documents to the pharmacy.
- Ask your doctor to include LU codes. Without them, coverage claims may be rejected.
- Consider biosimilars or generic alternatives. Pharmacists can help you switch to lower-cost options without sacrificing effectiveness.
Support from Your Pharmacy in Richmond Hill
Navigating coverage criteria and drug programs can be complex, but you don’t have to do it alone.
At Viva Health Pharmacy in Richmond Hill, our pharmacists can:
- Check which diabetes medications are currently funded under OHIP in 2025
- Submit ODB and Trillium claims on your behalf
- Monitor your blood-glucose management and refill schedule
- Advise on diet, supplements, and lifestyle habits that support treatment
Our goal is to ensure you receive the right medication with the least financial burden possible.
As of 2025, Ontario offers strong support for people managing diabetes through its public drug programs.
From foundational treatments like Metformin to advanced options like Ozempic and Jardiance, OHIP and ODB help make essential care accessible to those who need it most.
If you’re uncertain which medications are covered for you, speak with your doctor and the team at Viva Health Pharmacy in Richmond Hill.
We’re here to help you understand your options and manage your diabetes with confidence and clarity.
