A few weeks ago, the PC government announced changes to OHIP+ drug coverage for Ontario residents under the age of 25. In less than two weeks, those changes will take effect across the province. Ontario's Ministry of Health has released a summary of the changes ahead of the start date in order to prepare us for what's to come.
Starting on April 1st, 2019, the provincial government will be shifting the focus of OHIP+ benefits to prioritize youth without a private plan. Ontarians aged 24 and under who are insured under a private drug benefit plan will no longer be eligible for medication coverage through OHIP+. Those who are not will continue to be OHIP-insured, eligible for prescription medication coverage by OHIP+ provincial healthcare.
In January 2018, the Ontario government decided to make OHIP+ drug coverage available to all Ontarians under 25, regardless of their private health benefits. As of April 1st, OHIP+ will be restructured under the new model.
According to the Ministry's statement, Ontarians under 24 with a private benefits plan will not be eligible for OHIP+ regardless of whether:
- "The private plan covers the particular drug for which coverage is sought
- the child or youth or another person captured under the private plan is required to pay a copayment, deductible, or premium, or,
- the child or youth has reached their annual maximum under the private plan and no further coverage is available."
Along with these changes, Ontario will also be launching a new assistance program called the Trillium Drug Program. This program is designed to help households with high prescription drug expenses, available to all OHIP-insured Ontario residents. To be eligible for assistance, the household's out-of-pocket drug expenses will be compared to the household's total income.
The purpose of these changes, according to the Ministry of Health, is to "recognize the important contribution of private insurers and employers in the provision of health benefits to Ontarians". In other words, give priority to young Ontarians without a private plan and allow insurance providers to pull their weight.
"In general, private plans cover more drugs than the Ontario Drug Benefit (ODB) program," their statement reads. "Therefore, children and youth could have access to more medications through their private plan than they do under the ODB program."
To read the full summary of OHIP+ changes, click here.