OHIP+ Update

OHIP+ is Ontario’s newly introduced drug benefit program for children and youth that was introduced on January 01, 2018. The previous Liberal government had agreed to cover the full cost of eligible prescription drugs under the Ontario Drug Benefit (ODB) program for people under the age of 25.

To learn more about OHIP+ please read our article, what is ohip+?

OHIP+ Will Become Second Payor

OHIP+ will now be transitioning to a second payor system. Christine Elliot, Ontario’s new Minister of Health and Long-Term Care, announced in June of 2018 that drug claims for people under the age of 25 must be paid through a private insurance plan first. The government would then pay the remaining cost of the eligible prescription. However, those who are not covered by private benefits would continue to receive their eligible prescriptions at no cost under the ODB program.

Why Are The Changes Being Implemented?

The changes to the current pharmacare program are part of the new Ontario Progressive Conservative government’s pledge to save billions each year by finding efficiencies in government spending.

OHIP+ coverage is said to now focus on Ontario residents who do not have existing prescription drug coverage, while saving taxpayers money.

How Will It Work?

The changes will require those who are covered by private plans to bill those plans first, with government covering all remaining costs of eligible prescription drugs. Additionally, private insurance plans cover thousands of drugs that the government formulary does not, making private insurance a more comprehensive solution.

When Will The Changes Start?

Private insurers had originally offered the Liberals a grace period for some medications, which expired on Canada Day. The Progressive Conservatives then asked the insurance providers to extend this term while they work out the details of the changes.

As of now, no definitive timeline has been provided by the Conservative Government as to when the new OHIP+ changes will come into effect.

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