Six months following the implementation of the OHIP+ drug coverage for Ontarians under the age of 25, the new provincial government is repealing it, at least in part.

Effective January 1, 2018, all Ontario residents under the age of 25 received full reimbursement of the approximately 4,400 prescriptions drugs covered under the provincial formulary.  Coverage for drugs under Ontario’s Exceptional Access program was slated to take effect on July 1, 2018, following a negotiated grace period with insurers.  When originally introduced, there was no indication of how the province intended to pay for this program.

On June 30, 2018, the new Minister of Health and Long -Term Care, Christine Elliott, announced a change to the program, so that those under the age of 25 with access to private insurance (Employer sponsored programs), would see that insurance once again become the first payer, with OHIP+ picking up the remainder for eligible drugs.  “This new system would be more efficient, saving the taxpayers money and dedicating resources to the people who need it most,” says Elliott in a press release. “Even more importantly, it would continue to guarantee that children and youth still receive the prescription drugs they need.”


When Will This New Change Take Effect?

There has been no effective date for the changes announced as yet.  For now, OHIP+ will continue to be first payer for the roughly 4,400 drugs on the ODB formulary.  Insurer claim payment systems were changed to accommodate the OHIP+ payment parameters and many insurers have recently notified claimants who have been receiving reimbursement for Exceptional Access drugs that as of July 1, they must apply to the government for continued reimbursement of these medications.  Ms. Elliott says the government will ask the insurance companies for an extension of this July 1 date, while the proposed changes to OHIP+ are worked out.  Claim payment systems now need to be changed again.


How Will This Impact the Cost of My Plan?

With this announcement coming during the Canada Day weekend break, insurers have not yet had a chance to respond.  Once a date is finalized for the change, employer plans will see those drugs revert to their plan.  Plans will be impacted to varying degrees.  Those with a significant population of employees and dependents under the age of 25 will be impacted the greatest while those with a higher average age and with fewer employees in Ontario will see modest to little change.

Administrative Services Only (ASO) and Retention plans will account for the pending change immediately as it happens, while adjustments on insured plans will be determined by individual insurers.  Some may adjust their rates at renewal and others on a fixed date.