Is OHIP+ To Be Just a Memory?

Less than 12 months ago, the government of Ontario announced the introduction of OHIP+ to provide prescription drug coverage for Ontarians under the age of 25. Coverage was restricted to drugs eligible under the Ontario Drug Benefit (ODB)—approximately 4,400 medications—without co-pay or deductible. If the patient was eligible for coverage under an employer’s benefit plan as an employee or dependent, a drug outside of the ODB could still be claimed against the employer’s plan. OHIP+ had the potential to offer a small degree of relief to an employer’s drug spend, but seldom greater than low, single digit percentage savings.

OHIP+ created some anxiety for parents, patients and prescribers when it came to high-cost specialty medications. Who is responsible for paying?  What type of documentation is required? But the Canadian Life and Health Insurance Association and the Ministry of Health and Long-Term Care worked out an arrangement to ensure the patient was not put at risk. Now, 180 days into OHIP+, the new government of Ontario has announced that the program will be coming to an end for Ontarians under age 25 who are covered under private insurance programs.

In the first 180 days of OHIP+, over 950,000 prescriptions were filled and provided free of charge to Ontarians under the age of 25.  One projection has suggested the program was going to cost over $600 million in 2018. What we don’t know is—once the program is revised and employer-sponsored plans are once again liable for these costs—how are patients who are taking high cost medications going to be transitioned off OHIP+? Perhaps the Ministry of Health and Long-Term Care could replace OHIP+ with OHIP+/-, or they could do away with it all together. Right now, we don’t know, but as always, we’ll be monitoring the situation closely.