Updates to government benefit plans in Ontario, Quebec and Alberta
There have been several recent announcements of changes to provincial government health care benefits that are summarized below.
OHIP Out-of-Country Coverage to Terminate
Effective January 1, 2020, the Ontario Health Insurance Plan (OHIP) will no longer cover any emergency medical costs for Ontarians travelling outside of Canada. Currently, coverage is limited to a maximum of $400 per day for inpatient care, and $50 per day for outpatient care or physician costs. It should be noted that most private extended health care plans include emergency out-of-country coverage that reimburses expenses well beyond the limits of provincial government plans.
FreeStyle Libre flash glucose monitors now covered under the Ontario Drug Benefit
Effective September 16, 2019, FreeStyle Libre flash glucose monitors have been added for reimbursement under the Ontario Drug Benefit. Flash glucose monitors are a newer blood glucose monitoring system that use a sensor worn on the upper arm. Patients use a reader or a phone app, waved over the sensor, to take an immediate reading of their blood glucose level. Such devices increase convenience for diabetics and have become popular.
Both the reader and the disposable sensors will be covered with a valid prescription for patients on insulin therapy.
Quebec launches vision care coverage for children under 18
Effective September 1, 2019, the Quebec government has launched the “See Better to Succeed” program. This program provides a reimbursement of $250 (which does not vary with the cost of the purchase) every 2 years for glasses or contact lenses for all children under the age of 18.
Alberta Budget includes biosimilar initiative and mental health investments
The 2019 Alberta Budget, released on October 24, 2019, included an announcement regarding prescription drug coverage changes and new funding for other areas of health care.
The budget noted that Alberta’s prescription drug costs are higher than other provinces partially due to program design. It announced that program changes will include a biosimilars initiative, as well as Maximum Allowable Cost pricing rules to limit drug benefit coverage to lower-cost alternatives that are clinically appropriate. The Alberta Senior Drug Benefit Program will discontinue coverage for nonsenior dependents and the government will explore applying an income test for seniors’ drug coverage.
The loss of OHIP travel coverage will mean private travel insurance plans will cover all costs for emergency out of country claims, and will likely result in travel premium increases for plans with plan members in Ontario. The quantitative impact of this change to private plans is not yet clear; however, given the provincial plan reimbursed a small portion of the total average cost of such claims, premium increases are expected to be minor.
Private plans providing coverage for vision care for individuals under 18 in Québec should encourage members to seek reimbursement under the See Better to Succeed Program prior to private plan reimbursement. Insurance companies will not be coordinating reimbursement under the program.
Though very little information is available regarding the Alberta change to utilize biosimilar drugs, it may be similar to the changes implemented earlier in 2019 by the British Columbia provincial drug plan. (See the September 2019 News & Views for further details.) Most private plan insurers are following suit to reimburse the biosimilar versions rather than the brand name biologic drugs for BC plan members. It remains to be seen if other government plans embrace forced switching of patients to biosimilars, since increased use of biosimilars will support the sustainability of both private and government drug plans.