If you live in Ontario, OHIP Plus will be effective as of Jan 1, 2018 which means the Ontario Drug Benefits Program will pay for a number of prescription medications for anyone below the age of 25. So what do you really need to know?
It means making sure you know where your health card is. When you go to your pharmacy to fill a prescription for your children or yourself if you are below age of 25, the Ontario Drug Benefits Program will pay for a number of prescription medications as long as they are listed in the formulary. The formulary does include a comprehensive list of medications including antibiotics, inhalers for Asthma, pain medication, hormone therapies as well as medications for ADHD. Some specialty medications may require prior authorization, via the Exceptional Access Program or additional documentation such as a Limited Use Code to confirm the therapeutic use is consistent with the program coverage criteria. But for the most part, many medications will be reimbursed directly to the dispensing pharmacy as long as there is a valid health card number and a valid prescription.
If you have a current prescription medication that is covered by a private insurance plan, it will be billed first to the Ontario Drug Benefits Program as of Jan 1 2018. If this prescription medication is not covered by Ontario Drug Benefits, then it may be continued to be billed to your private insurance plan.
The OHIP Plus is set up to be no charge to the patient – no deductible, no copay, nothing out of your pocket! It is definitely a great program for families where children may be taking many medications that are currently being paid out of pocket by the families.
To find out if a prescription medication is covered by OHIP Plus, an app has been developed to help you navigate through the formulary. Check it out for yourself.
In the meantime, I have noted at least the following points:
- Epipen is covered as long mas a special authorization form is completed. (Addendum – As of Dec 1 2017, special authorization form is no longer required)
- Many liquid medications such as ibuprofen (Advil) or diphenhydramine (Benadryl) for infants and toddlers are not covered by OHIP Plus at this time.
- Other common remedies such as Pedialyte or Vitamin D Drops are not covered at this time.
I suspect the formulary will evolve with time to better reflect medication needs of this population. In any case, OHIP Plus is indeed great news for many Ontarians. I encourage everyone to learn more about this program to take full advantage for their children and youth.
I hope you find this post helpful. Thank you for reading my post.