OHIP + For Under 25
Ontario became the first province in Canada on Jan. 1, 2018 to start providing free prescription drugs to all children and youth under 25. The government covers the cost of 4,400 (ODB Formulary) commonly used drugs such depression and anxiety medications, insulin and diabetic test strips, antibiotics, asthma inhalers and birth control pills.
Those drugs will be covered with no deductible or dispensing fee at any pharmacy as long as patients have a valid prescription and OHIP card. The government estimates the cost of the program with be $465 million although other research shows the cost closer to $885M.
Until June, private insurance companies will continue to cover as many as 10,000 additional drugs for subscribers. Until that time, and after June, the government will also fund many of those additional drugs on a case-by-case basis through an existing Exceptional Access Program (EAP). In this case, the patient’s doctors or nurse practitioner will need to fill out and submit the application by fax to the government by approval.
It won’t be until 2019 when the insurance industry has a full year of plan experience that rates will be adjusted. PHA will be monitoring prior and current year dependent plan experience to estimate the impact of this program on costs. We will be providing this update in all annual reviews that take place for the next 20 months (until the end of 2019) providing there are no changes to the program. Get in touch with us if you would like more information.