OHIP+: Prescription Medication Children and Youth

What we’re monitoring that could impact your benefit program:

The Ontario government tabled “OHIP+: Children and Youth Pharmacare”, a new prescription drug coverage program for Ontario children and youth under the age of 25 to be effective January 1, 2018. Extensive details of the program are not available, so we’re monitoring this closely to determine the benefit plan impact on you.

What’s been tabled?

All prescription drugs covered under the Ontario Drug Benefit (ODB) formulary will be provided free of charge to Ontarians up to and including age 24, regardless of family income. There will be no deductible and no co-payment. Currently, Ontario residents over age 65 have access to the ODB, a formulary of approximately 4,400 drugs.

Impact on insurance plans

By making the government the “first payer” for young Ontarians’ eligible prescription drug expenses, we suspect there may be some cost relief on plans that provide group prescription drug benefits to employees’ eligible dependents. We are cautious on the extent of the savings:
• The under 24 age bracket has very low drug spend (relative to the overall plan and other age categories)
• Only drugs eligible on the ODB formulary would be paid (ODB is a more restrictive formulary than private drug plans)
• As high cost medications continue to be introduced to the market any potential savings may be impacted by the other influences that impact the higher age brackets.

Next steps

CBA Canada will continue to track updates on this proposed government program. As details are ironed out over the next few months, we will keep you posted on the potential changes and implications to you. If you have any questions please feel free to contact your CBA consultant.