VIEWPOINT: Selectivity and access issues embedded in new OHIP+ program

By Nicole Babb

OHIP+, a new provincial pharmacare program that covers more than 4,400 prescription medications for Ontario residents under the age of 25, is a misguided attempt at improving drug coverage in Ontario.

All prescription medications covered by the Ontario Drug Benefit program are now covered by OHIP+, regardless of a person’s level of private insurance coverage.

The new program, which was initiated by the Ontario Liberal government, came into effect on Jan. 1 and has been problematic from the start.

One of the main problems with the new program is that it misses the mark on who to insure.

More than half of Ontario residents under the age of 25 already have medication coverage under private insurance plans, according to a recent study conducted by the Conference Board of Canada. This means the new program will cover 2.1 million people who were already insured, transferring expenses from private insurance companies to taxpayers.

The new program is expected to cost Ontario taxpayers $465 million annually. This is an inefficient use of funds.  If the government had left the private insurance plans in place and focused on insuring people without coverage, all youth would still be covered but at a lower cost to taxpayers.

Finance Minister Charles Sousa told CBC that the reason the government decided to apply the plan to those who already have coverage was to insure equal access to medication.

“Even with those who have plans, they still have co-pays and deductibles and that’s a significant expense on them,” he said.

However, people with insurance can still afford needed medications so publicly funding drugs for these people makes little sense.

Many experts in the field agree that the program is flawed.

“If you’re going to take on extra costs, it should be to cover people who didn’t have coverage and needed it, not cover people who’ve already got it,” Helen Stevenson, former executive officer of Ontario Public Drug Programs, recently told TVOntario.

Conservative critic Jeff Yurek has said that OHIP+ will lead to savings in the insurance industry while some Canadians still go without coverage.

After the implementation of OHIP+, there will still be 614,700 Ontarians between 25 and 64 without access to any drug coverage, according to the conference board study.

To make matters worse, people who were previously covered effectively under private insurance plans are now experiencing problems with coverage under the new program.

Ottawa resident Derek Heebink recently told CTV that his son uses inhalers that were formerly covered under a private insurance plan. But when Heebink tried to fill his son’s prescription last week under the new provincial plan, he was left with a bill of $130 since his son’s inhalers are not on the current list of drugs covered by OHIP+.

Similar cases have been reported across Ontario.

Scott Coulter, a pharmacist in London, told CBC that since the implementation of OHIP+, situations like these are happening every day in pharmacies across the province.

Some people now have to pay for certain medications. If the medication you need is not amongst those already covered, you can ask a doctor or nurse to help you apply for coverage under the Exceptional Access Program.

However, decisions concerning coverage can take anywhere between three days to six weeks since the program receives hundreds of applications every day, according to the website.

Cleary, the new OHIP+ program is not the ideal way to improve access to pharmacare in Canada. Leaving private insurance plans in place and creating a program that more directly targets people without previous coverage would be a better, more cost-effective solution.