Trillium and private insurance
Before Trillium records the quarterly deductible as met, bill private insurance first. The patient sends eligible out-of-pocket receipts and proof of the insurer payment to Trillium. This is not ordinary online secondary billing.
ODB carrier IDs, dispensing fees and vacation supply
Trillium
OHIP+ patient in a Trillium household
Age 24 or younger, with OHIP and no private drug plan: bill through OHIP+ with Special Service Code U on every claim. The family's Trillium enrolment does not require ML or Carrier S. OHIP+ has no deductible or co-payment; its paid claims do not count toward the household's Trillium deductible.
If that patient has private drug insurance: they are not eligible for OHIP+, even if the plan excludes the drug or its annual maximum is exhausted. Do not use U. Follow the Trillium/private-insurance sequence below. Check whether the patient is covered, not just whether another household member has insurance.
ZR or PM: reconfirm private-plan status. No private plan: resubmit with U. Private plan: bill that plan and send eligible out-of-pocket receipts to Trillium. These responses do not themselves require ML; Carrier J and Adjudication Code ML apply only to a qualifying OHIP+ eligibility rejection.
Application timing and earlier receipts
Receipts from before applying can qualify. For a first application, choose an enrolment start date within the eligible program year, as early as the first eligible receipt from August 1. Prescriptions before that start date are not covered and do not count toward the deductible. The start date affects the deductible and cannot be changed after enrolment is confirmed.
Eligible out-of-pocket costs count toward the quarterly deductible; only eligible amounts above it are reimbursed. Keep official pharmacy receipts and private-insurer payment statements.
Deadlines: apply by September 30 after the program year ends; submit receipts and supporting documents by October 31. For 2025/26, those dates are September 30 and October 31, 2026.
How long to hear back? The current guide gives no fixed processing time. Missing signatures or income information can delay enrolment. For the current turnaround or application status, call 1-800-575-5386.
How to coordinate Trillium with private insurance
Before Trillium records the quarterly deductible as met, the private insurer and Trillium are not submitted as two online claims at the pharmacy. The pharmacy bills the private plan, the patient pays the remaining eligible amount, and the patient sends the required proof to Trillium for manual processing.
Before the quarterly deductible is met
What Trillium does after receiving the documents
Trillium manually credits the eligible out-of-pocket amount to the household's quarterly deductible. If the submitted eligible amount is more than the deductible still owing, Trillium reimburses the eligible excess.
Amounts paid by private insurance, a manufacturer, or a discount card do not count toward the deductible.
Unpaid deductible carries into the next quarter
If the household does not pay its full deductible in a quarter, Trillium adds the unpaid amount to the next quarter. This happens automatically; the pharmacy does not submit a separate carry-over claim.
Example
If each quarter starts at $250 and only $200 counts toward Q1, the unpaid $50 moves to Q2. The Q2 deductible becomes $300: its own $250 plus the $50 carry-over.
After Trillium records the deductible as met
After Trillium records the quarterly deductible as met, submit ODB-eligible prescriptions electronically to TDP for the rest of that quarter, with up to a $2 co-payment. The ODB claim response shows the TDP payment and patient co-payment.
Maximum days supply
August 1 to February 20: ODB may allow up to 100 days, subject to the prescription and product rules.
February 21 to April 30: the limit drops by one day each day so a claim cannot extend more than 30 days past the end of quarter 3. February 21 allows 99 days; February 22 allows 98.
May 1 to July 31: coverage cannot extend more than 30 days past the July 31 benefit-year end. Use the maximum days supply returned in the ODB response.
Worked examples
Only the household-paid amount counts
On an illustrative $80 prescription, a private plan pays $60 and the patient pays $20. If the full $20 meets Trillium's eligibility rules, it can be credited toward the deductible. The insurer's $60 cannot. Submit both the official receipt and proof of the private-plan payment.
A child can use OHIP+ while the household uses Trillium
A 12-year-old has OHIP and no private drug insurance. Bill OHIP+ with U even though the parents use Trillium. The child's OHIP+-paid prescriptions do not reduce the household's Trillium deductible. If that child has private coverage, use the private-insurance route instead, even when the plan excludes the particular drug.
These examples apply the linked Ontario reference manual and Trillium guide; they are not payment guarantees.
Sources and scope
Independent pharmacy-facing reference, not an Ontario government service. The linked Ontario manuals and program guides control eligibility and payment. Source links appear beside the applicable rules. Confirm the current claim response and retain the required documentation.
Ontario Drug Programs Reference Manual (revision 17, August 3, 2026); program guides and dispensing-fee notices linked above.
Source-verification policy | Report a correction. Do not send patient or claim identifiers.