What You’ll Learn
This course covers real-world Ontario pharmacy billing challenges — from Trillium to ODB to insurance billing — in plain English, no jargon.
Course Curriculum
Module 1: Provincial Drug Plans
Key Topics:
Ontario Drug Benefit (ODB) Program: Who is covered and how it works
Eligibility criteria for seniors, long-term care residents, ODSP, OW, etc.
Deductibles and co-payments (Trillium Program included)
How prescriptions are processed and billed through ODB
Module 2: Special Programs Under ODB
Key Topics:
Exceptional Access Program (EAP): When and how to apply for drugs not covered by ODB
Special Drugs Program (SDP): Covers life-saving medications for diseases like cystic fibrosis, HIV, and organ transplant
Nutritional Products, Limited Use Drugs, and Facilitated Access
Real-life billing and documentation tips for pharmacy staff
Module 3: Federal Drug Plans
Key Topics:
Non-Insured Health Benefits (NIHB): Covers First Nations and Inuit patients
Veterans Affairs Canada (VAC): Drug plans and billing for military veterans
Correctional Services & Canadian Forces health coverage
Differences between federal vs. provincial billing workflows
Tips for navigating federal claims and ensuring compliance
Module 4: Support Drug Plans
Key Topics :
Trillium Drug Program (TDP):
For Ontarians facing high prescription costs relative to income.
Ontario Works (OW) and Ontario Disability Support Program (ODSP):
Drug billing for recipients of social assistance or disability support.
Long-Term Care (LTC) and Home Care:
Coverage nuances for patients in residential or assisted living care.
Tips on verifying eligibility, avoiding duplicate billing, and properly categorizing patients.
Module 5: Private Plan
Key Topics :
Types of private insurance: Employer plans, student plans, family plans, etc.
Coordination of Benefits (COB):
Handling situations where patients have multiple coverages
Adjudication platforms like Telus Health and ClaimSecure
Common errors in third-party billing and how to avoid rejections
Tips for real-time claim processing and managing co-pays
Module 6: Assessment
This final module will include a short quiz to help you review and test your knowledge from all 5 modules. It will cover:
Provincial & federal plans
Special program eligibility
Private insurance scenarios
Real-world billing decisions
You’ll receive immediate feedback and guidance so you can feel confident applying everything you’ve learned.