OHIP+, which began on January 1, 2018, currently provides free prescription drug coverage for all Ontario children, youth and young adults age 24 and under who have OHIP coverage. With the child/youth/young adult’s OHIP health card or health care number, pharmacies fill prescriptions for people 24 and under without any charges, dispensing fees, co-payments or deductibles. People 24 and under are automatically covered by OHIP+, with no requirement to enrol or register. OHIP+ fully covers the cost of more than 4,400 drug products that are currently available through the Ontario Drug Benefit program.
Beginning on April 1, 2019, OHIP+ will no longer be universal:
- OHIP+ will continue for people age 24 and under who do not have private insurance.
- People age 24 and under who receive Ontario Works/Ontario Disability Support social assistance or home care, or who are resident in certain care homes will be eligible for the Ontario Drug Benefit program without any deductibles or co-payments, whether they have access to private insurance drug coverage or not.
- People age 24 and under who are in any way captured by private insurance drug coverage will no longer have any drug coverage under OHIP+. It does not matter whether the private insurance actually covers the drug(s) prescribed, or if there are deductibles, co-payments or other limits. If they or their families are left with significant prescription drug costs that are not covered by the private insurance, they can access the Trillium Drug Program (the Trillium Drug Program requires the payment of an annual deductible based on household net income and a co-payment for each prescription – see link below).
There are many questions about how the OHIP+ change will actually be implemented. When we prepared this post in late March 2019, there had been very little information about implementation.
People living with HIV in Ontario can contact HALCO for free legal advice about OHIP+, access to prescription medications, or any other legal issue: https://www.halco.org/contact-us.
Here is a link to a Ministry of Health and Long-Term Care Bulletin dated February 27, 2019, about the OHIP+ changes: http://www.health.gov.on.ca/en/pro/programs/drugs/opdp_eo/notices/exec_office_20190227.pdf.
Here is a link to information about the Trillium Drug Program: https://www.ontario.ca/page/get-help-high-prescription-drug-costs.
This information is also available as a printable info sheet in pdf: https://www.halco.org/wp-content/uploads/2019/03/OHIP_change-2019Apr1.pdf.