OHIP+ offers free prescription drugs for anyone under 25. But there are limits.
If someone needs to access drugs that aren't among the 4,400 medications covered by the Ontario Drug Benefit Formulary, they have to submit a request through Ontario's Exceptional Access Program (EAP). The EAP process is long and convoluted and many physicians are being inundated with patients showing up with EAP forms wanting to get them filled out… And the forms take time to complete.
According to the Conference Board of Canada, the introduction of OHIP+ provided prescription drug coverage to 1.2 million Ontarians who previously had no private insurance. This is a real plus for many families.
However, it also transferred an additional 2.1 million people who already had private insurance to public coverage under OHIP+. If a drug isn't covered by OHIP+, private insurance companies may refuse to cover the drug. They say it's because OHIP+ is supposed to be the primary payer for medication for those under 25.
Bottom line: some people are now paying out of pocket for medications that were covered under their plans before OHIP+. And that doesn't feel like a plus at all.
Read about Jackie Bain's struggle to get medication covered for her son.