What you must know about OHIP+

On January 1, 2018, Ontario government introduced the OHIP+ healthcare program – free prescription medications for everyone under the age of 25. It has been the biggest expansion to medicare in Ontario in a generation, providing drug coverage to over four million children and youth across the province.

This expansion of medicare marked a turning point for Ontario families, who started getting access to life-saving drugs without having to worry about affordability. Coverage has been automatic for children and youth with an OHIP card and a valid prescription. There are no upfront costs, no co-pays and no strings attached.

OHIP+ has given young people access to more than 4,400 drug products reimbursed under the Ontario Drug Benefit program, including some of the most commonly used medications and those available through the Exceptional Access Program, if an individual qualifies, at no cost.

An estimated 1.2 million people in Ontario without drug coverage benefit from OHIP+. This is according to a recent report by the Conference Board of Canada that estimates a drop from 13.2% to 4% in the number of people not currently eligible for drug coverage under a public or private insurance plan in Ontario.

What medications are covered with OHIP+

OHIP+ covers prescription medications listed on the Ontario Drug Benefit Formulary and additional medications eligible for funding through the Exceptional Access Program and prescribed by a doctor or nurse practitioner.

OHIP+ completely covers the cost of more than 4,400 drug products that are currently available through the Ontario Drug Benefit program, including:

  • antibiotics to treat infections
  • inhalers for asthma
  • various insulins, oral diabetic medications and diabetes test strips
  • epinephrine auto-injectors (e.g. EPIPENs®)
  • drugs to treat arthritis, epilepsy and other chronic conditions
  • medications to treat mental health conditions (e.g. antidepressants)
  • attention deficit hyperactivity disorder (ADHD) drugs
  • drugs to treat some childhood cancers and other rare conditions
  • help to quit smoking: up to a year of pharmacist-assisted counseling (talk to your pharmacist or health care provider) and drugs (Champix or Zyban) if you are age 18 years or older.


Important changes to OHIP+ (June 2018)

Recently, the Ontario government announced important changes to the OHIP+ program making OHIP+ more cost-effective. Benefits are focusing on those who do not have existing prescription drug benefits. In other words, the government no longer offers free prescriptions to kids and young adults under 25 with private health insurance coverage.

The new system would be more efficient, saving the taxpayers’ money and dedicating resources to the people who need it most. Even more importantly, it would continue to guarantee that children and youth still receive the prescription drugs they need.

Children and youth who are not covered by private benefits would continue to receive their eligible prescriptions free. Those who are covered by private plans would bill those plans first, with the government covering all remaining eligible costs of prescriptions.

Since insurance plans can cover thousands more drugs than the 4,400 currently available through OHIP+, children and youth would have access to more medications than under the current program.



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