Within 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% to the overall health budget.

What is OHIP+?

OHIP+, introduced January 1^st, 2018, is a program which covers the cost of eligible prescriptions for people under the age of 25.  It’s known as an Ontario health care program with a no-strings-attached approach: no co-pay, no dispensing fees, and no deductibles. Unlike other provincial plans, Ontarians also don’t have to provide any information into how much the individual under 25 or their family earns per year.

Who is covered?

All babies, children and youth aged 25 and under who have OHIP coverage are now covered by OHIP+. OHIP+ coverage will stop on the patient’s 25th birthday.

How does it work? 

The coverage is automatic, which means there is no need to enrol or register for OHIP+. A person under 25 (or a parent) can take the prescription and their Ontario health card to a pharmacy anywhere in Ontario and have it filled free of charge. The program aims to help Ontario residents by giving them access to medications they need, without having to worry about not being able to afford it. The plan currently covers 4,400 drugs. However, it does not include all medications available under the Ontario drug benefit – the more expensive drugs are not covered.

It is important to advise your clients that not all drugs are covered by OHIP+ and to encourage them to check the list of approved medications online before taking their prescription to a pharmacy.

Examples of common drug products used by children and youth, age 24 and under that will be covered by OHIP+ include:

• Antibiotics to treat infections
• Inhalers for asthma and breathing conditions
• Various types of insulin, oral diabetic medications and diabetes test strips
• Epilepsy drugs
• Medication to treat mental health conditions and antidepressants
• Attention deficit hyperactivity disorder (ADHD) medication
• Drugs to treat childhood cancers and other rare conditions

Opting out

All Ontario patients under the age of 25 are automatically covered under OHIP+. Any individual who does not wish to receive coverage under the OHIP+ program can opt out by contacting ServiceOntario’s info line at 1-866-532-3161.

OHIP+ also offers the Exceptional Access Program for medications not currently covered by the Ontario Drug Benefit.

Since not all medications are covered by OHIP+, your clients can apply for the Exceptional Access Program. It is important to let your clients know about this program and instruct them to apply by filling out the application with their family doctor. The application will be reviewed by pharmacists that specialize in the Exceptional Access Program and determine whether or not their medication should be covered for free under OHIP+.

We would love to know what you think about Ontario’s new OHIP+ program.
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