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OHIP+ changes announced by new Ontario government

On June 30, 2018, the new Ontario government announced their intention to amend the OHIP+ youth pharmacare initiative which was introduced earlier this year by the previous Liberal government. The goal is to make OHIP+ the second payer for Ontarians under age 25 who have drug coverage through private drug benefit plans. Ontarians under age 25 who are not covered by a private drug benefit plan will continue to have access to the approximately 4,400 drugs included in the Ontario Drug Benefit Formulary.

The announcement did not provide details on how the government will implement this change. Following the introduction of OHIP+ earlier this year, the OHIP+ program became the first payer for all Ontarians under age 25, although private insurers had given the government a grace period in which they continued primary coverage for some medications until July 1, 2018. The government has asked for an extension of this grace period in order to implement the recently announced changes.

The Ministry of Health and Long-Term Care has subsequently advised that OHIP+ will continue in its current form while they work with private insurers and other stakeholders to effect the proposed changes.


Comment

The impact of the change will vary from plan to plan but employers and plan sponsors should anticipate that any cost savings they may have realized or expected to realize under the original OHIP+ program will likely be negated. The timeframe for the announced changes is not yet known.


News & Views - August 2018 (PDF)