If you have a child with a chronic illness, severe allergy or asthma, chances are you spend hundreds on EpiPens, inhalers or other drugs every year. But starting January 1, 2018, if you live in Ontario, you no longer have to. A new program called OHIP+ covers the cost of all prescriptions for people under 25. We asked the Ontario minister of health and long-term care, Eric Hoskins, to give us the details.
How does OHIP+ work? We have intentionally made it really, really easy for parents and for young people. All you need to do is go into any pharmacy in Ontario with a prescription and your health card number and the pharmacist will fill your prescription for free. There's no cost, no co-payment, no annual charge—it’s absolutely free.
Are there caps on how much medication you can get? No, it’s whatever your healthcare provider prescribes for you. It’s going to make a huge difference for families where the kids need multiple EpiPens, kids with diabetes, those with asthma, and a dramatic impact on the families of children with cancer, rare diseases or chronic conditions, who often have costs in the thousands or even tens of thousands of dollars.
What if you’re covered by a private plan? We are first payer on this program [so] and it offers you access to 4,400 drugs. There may be instances when, if you’re getting a brand-name drug from your private insurance, we will substitute a generic drug.
We’ve been in discussions with insurers since the beginning, and with the savings that they see when their cost of drugs goes down, they will either be reducing their premiums or negotiating with employers and employees to expand their benefits in other ways. So it’s really a win for everyone.
Why is drug coverage for kids so important? It’s estimated that one in every 10 families in Canada doesn’t fill their prescriptions and doesn’t take their medications because they can’t afford them. They have to make that choice between buying medication and putting food on the table. We believe that this is essential—that access to medications is just as important as access to the hospital or to your family doctor. So we wanted to eliminate any barriers to it.
This will cost about $450 million annually, but it’s an important and worthwhile investment. What ends up happening when kids don’t get prescriptions filled is that they get sicker and they show up in our emergency departments or end up getting hospitalized. So costs are incurred if we don’t provide access to the medications. That’s the same argument health economists make when they look at national pharmacare as well: The return on investment is substantial.
Do any other provinces have similar programs in place? No, we’re the first. But for the past three and a half years or so I’ve been pushing for national pharmacare for all Canadians. There’s been a tremendous amount of interest in that by my colleagues and by other provinces, and we’ve come a long way in our discussions about that. OHIP+ is one of the first steps, and it’s demonstrating to our colleagues across the country that this can be done right. I truly believe national pharmacare is inevitable in this country—it was always envisioned as the second piece of medicare, even back in the 1960s—and we will find our way to that.
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