In the recent provincial budget, the government announced a new pharmacare program called OHIP+. This program will cover 100% of the costs of medications for everyone from birth up to 24 years of age (inclusive), with no co-pays and no deductibles. An OHIP card is all that is needed. This program will cover prescription medications and nutritional products listed on the provincial formulary as well as drugs approved on a case-by-case basis through the Exceptional Access Program. If the program is approved then coverage will begin on January 1, 2018.
News release - April 28, 2017:
The provincial Minister of Health and Long-Term Care has been a strong advocate for a national pharmacare program over the past few years. The announcement of a provincial child/youth universal pharmacare program is being promoted as a step towards the goal of national pharmacare.
National pharmacare is a goal that the Canadian Epilepsy Alliance has been supporting through our involvement with the Best Medicines Coalition (see BMC’s Core Pharmacare Principles) and is a goal that Epilepsy Ontario shares. Canada is the only industrialized country with public health care that does not cover prescription drugs.
Statements in support of OHIP+ from the Best Medicines Coalition and Epilepsy Ontario:
“Expanding the Ontario Drug Benefit Program to include children and youth is a significant step forward in improving patient care and outcomes. We welcome this announcement and look forward to working with Ontario and governments across the country to make sure that all Canadians are able to get the medicines they need.” ~ Gail Attara, Chair, Best Medicines Coalition
“Prescription medications are a crucial part of health care and should be a key component a universal public health care plan. The Ontario government’s proposal to provide drug coverage to everyone from birth to age 24 is a historic and important step towards this goal and will benefit more than 20,000 children and young adults living with epilepsy in Ontario. Epilepsy Ontario congratulates the government for investing in the health of children and youth and encourages continued efforts to help Ontarians access the medications they need, when they need them.” ~ Suzanne Nurse, Director of Information and Client Services, Epilepsy Ontario
Patient Impact Stores and Examples:
Request from the Office of the Minister of Health and Long-Term Care:
Would your organization have any patient impact stories or examples of how OHIP+ may help children and youth access the medications they may need through the OHIP+ program versus current potential gaps in their care or treatment?
If you have some ideas, stories or examples, please share them as we are interested to hear more. The Minister may also be interested in commenting on these stories or examples.
If you have any concerns related to the proposed child/youth pharmacare program, please share them as well. Epilepsy Ontario is very supportive of a universal child/youth pharmacare program for the health and well-being of children and young adults under 25 who are living with epilepsy, and the assistance this will provide their families. We are wary, however, of the implications this will have when coverage ends for people with chronic conditions, including epilepsy. Young adults in their mid-20’s are entering the workforce but may have precarious or part-time employment, with minimal or no benefits. This is a critical time for young adults to gain confidence, experience and job skills. The loss of public drug coverage at age 25 could have a detrimental impact at this crucial stage in life. In addition, the options for private coverage are extremely limited for people with a pre-existing condition.
Informed decision-making during treatment selection, including cost of treatment, will continue to be an important and necessary component of patient-centred care for children and youth because individuals who continue to have active epilepsy as they enter adulthood may have to sustain their medication costs themselves, out-of-pocket, once they reach their 25th birthday.
Another concern is that the addition of child/youth pharmacare to the Ontario Provincial Drug Programs amplifies the inequity for those who find themselves bookended by youth and seniors pharmacare programs and do not qualify for drug coverage. The majority of Ontarians living with epilepsy are between the ages of 25-64. Adults who do not have private coverage through their employer (or spouse’s employer) and who do not qualify for provincial disability benefits or other social assistance programs will continue to pay out-of-pocket for their medications. The Trillium Program may provide some financial assistance when drug costs are high, relative to household income, but the annual deductible can still be a significant burden.
We hope a successful child/youth pharmacare program in Ontario will highlight the importance of universal drug coverage as a key component of public health care and that a truly universal pharmacare program, with no age test, will quickly follow.