On January 2, 2019, the Ontario Ministry of Health and Long-Term Care introduced proposed changes to OHIP+ beginning in March 2019.
Should the proposed legislative changes be passed:
- Children and youth (excluding social assistance recipients, recipients of home care, and residents of homes for special care or a community home for opportunity) with private insurance would access prescribed medicines as they did before the launch of OHIP+, through their private insurer as the first payor.
- Individuals or families who have significant out-of-pocket costs despite having private insurance coverage could apply for additional financial support through the Trillium Drug Program, as was done before the implementation of OHIP+ on January 1st, 2018.
What does this mean to an employer’s sponsored benefit plan drug cost?
Whatever the savings were when OHIP+ was introduced will be lost.
Anticipated cost increases to the drug spend are in the five to eight percent range.
What do eligible children and youth need to do if they are still taking a high-cost, specialty drug which had previously been covered under a private plan?
We have not had any communications from insurers or the Canadian Life and Health Insurance Association on a transition plan back to the private payer.
We will communicate on any transition plan developments as they become available.
If you have any questions about the proposed changes, please contact your Cowan Insurance Group consultant for assistance.