Jodie Vanderslot | Health Editor
Featured image: Is OHIP+’s new drug coverage plan too good to be true? | Basma Elbahnasawy
All Ontario children and adults younger than 25 will receive the majority of their prescription drug costs completely free under the new provincial pharmacare program, regardless of income or private insurance.
As of January 1, OHIP+ came into effect and represents the largest expansion of Medicare in Ontario.
Those 24 years and under are automatically covered under OHIP+: Children and Youth Pharmacare; there is no additional registration required. That means approximately four million children and young adults will be covered through the Ontario Drug Benefit program, thereby neither group will have to go through private insurance or pay dispensary fees.
OHIP+ is the first program of its kind to successfully launch in Canada.
This new pharmacare plan fully covers more than 4,400 drug products and prescriptions, including, but not limited to: antibiotics, inhalers for asthma, EPIPENs, insulin and oral diabetic medications, treatment for chronic conditions, Pharmacy Smoking Cessation Programs, certain paediatric cancer medications, birth control, and medications that treat various mental health conditions, such as depression and ADHD.
Most group health programs define a dependent child as someone under the age of 21, or in full-time attendance at an accredited post-secondary institution and under the age of 25. The aim was to support low-income families, large families, single parents with children, students, and young people who are in the workforce, and those who are unemployed/underemployed. This plan was proposed by the Liberal Party, and was one of two options that were intended to take a step towards universal pharmacare.
“I think they both have their pros and cons, but it is a great step towards universal health care,” says Fatima Barrow, a fourth-year Children’s Studies student.
The second proposal, brought forth by the NDP’s, was to cover 120 drugs for all Ontarians.
Although this proposal was not chosen, many are arguing that if the aim is universal pharmacare, the NDP’s plan would have been a better first step. Many are arguing that in order for real progress and success to have been achieved, the government should cover all vulnerable persons, including those over 65. Unlike the Liberals, the NDP’s proposal would have made drugs available to everyone, not just to those under 25.
Prior to OHIP+, coverage included prescription medications for about 600,000 people within the age bracket, with more than 370,000 already on social assistance. Of all age groups, youth are the most cost-effective to cover at this time.
The Ontario government estimates it will budget $465 million a year to cover the prescriptions of four million individuals. However, if the implementation of this plan is effective and successfully received, universal coverage and access for those between the ages of 25 to 65 could be in the future.
Across Canada, Ontario is among the top-spending provinces for drugs per-capita, according to the Canadian Institute for Health Information’s 2016 data. As a result, Ontario is making moves to increase their investment in health care, spending an additional $7 billion over the next three years, which is an increase of 3.3 per cent to the overall health budget.
Additional medications are eligible for funding through the Exceptional Access Program (EAP), which facilitates access to drugs not funded through the ODB Formulary and not covered under OHIP+. If you require a drug that is not currently covered, or in situations where no listed alternative is available, application through the EAP is necessary.
However, until June, private insurance companies will continue to cover as many as 10,000 additional drugs. A patient’s doctor(s) or nurse practitioner(s) will fill out and submit the application by fax to the government for approval.
OHIP+ does not allow doctors to increase dosages or frequency of costly drugs for many illnesses without proper approval.
