OHIP+: Children and Youth Pharmacare will allow Ontario residents aged 24 years and under to have access to many prescription drugs at no cost starting on January 1, 2018.
If you (or a dependant) is aged 24 years or under, there are about 4,400 drugs that will be paid for under the Ontario Drug Benefit (ODB) program for OHIP+ eligible recipients and these will be processed and paid for right at your pharmacy. No other action will be required. You can check if your medication is covered through the ODB program at: www.ontario.ca/page/check-medication-coverage/.
There are also other drugs, such as Exceptional Access Program (EAP) drugs, that will require your doctor (or in some cases a nurse practitioner) to fill out a form before OHIP+ will cover them. Also, if a drug is not available through the ODB program, it will not be covered through OHIP+.
Do I need OHIP+ if I, or my dependant, already has insurance through a Group Plan?
Yes. Prescription drugs that are covered by OHIP+ must be processed at your pharmacy through OHIP+ first, even if you have private insurance coverage – such as a group benefits plan. If there is an unpaid balance it may be eligible under your group benefits plan.
Do I need to sign up?
No. You simply need your Ontario health card number and a valid prescription.
What happens if I, or my dependant, is taking a drug that’s not funded through the ODB program?
If you or your dependant are taking a medication that is not funded through the ODB program, the drug will not be funded through OHIP+. Your pharmacy can submit the expense to your group benefits plan for consideration.
I use EpiPen®s
EpiPen® auto-injectors are covered through the ODB program and will be funded under OHIP+.
Will my doctor need to fill out a form first – through the Exceptional Access Program?
Exceptional Access Program (EAP) drugs require your doctor or a nurse practitioner to submit a form to the government before you can be approved for coverage under OHIP+.
These are generally specialized drugs that are only taken by a small percentage of people. If an EAP drug is still being prescribed to you or a dependent, contact your doctor (or nurse practitioner) to see if there is an alternative and suitable drug covered on the Ontario Drug Benefit formulary or ask them to make an EAP request.
If your drug is approved for funding through EAP, your physician will be notified and your pharmacist can process the drug through OHIP+. If your request is denied the drug may still be eligible under your group plan and you will need to provide proof that your application for EAP drug coverage was denied through OHIP+.
The Group Insurance companies are doing their best to communicate directly with those members who may currently be taking an EAP drug so their physician or nurse practitioner can submit any required paperwork.
Still have questions? For more information go to www.ontario.ca/ohipplus.