New universal drug program in Ontario

On April 27, 2017, the Ontario government tabled its budget for the coming year. This budget provides that, beginning January 1, 2018, Ontario would offer a free universal drug program, OHIP+, for children and youth under the age of 25. We are still waiting for the bill to confirm this new plan.

Listed below are the key features of this new universal program:

• Coverage for Ontarians under the age of 25, regardless of their current coverage or the availability of private coverage
• Coverage for over 4,400 drugs, i.e., the same coverage offered under the Ontario Drug Benefit (ODB) Program
• First payer
• No deductible
• No co-payment; and
• No annual premium

In addition, OHIP+ will cover drugs listed under the Exceptional Access Program, which will provide access to many expensive drugs, including drugs used to treat cancer and rare diseases.

Private plans sponsors should initiate a reflection process in anticipation of the adoption of OHIP+. Outlined below are a few things that should be included in this reflection, if the Ontario program were to be adopted in its current version on January 1, 2018:

Group benefits plan premiums for Ontarians will need to be reviewed. National organizations should therefore examine the need to establish separate pricing for their Ontario members. They should quickly check with their insurer to find out whether their administrative and contractual structure allows for such an adjustment.

Organizations should consider upon the definition of eligibility of dependent children, taking into account distinct provincial particularities. Most group benefits plans in Canada currently allow students to remain insured if they are under age 26. Ontario’s new program will cover only youth under age 25.

Many private plans cover a list of drugs that is more generous than the ODB list. Organizations should determine whether or not they want to continue to offer this expanded list and act as the first payer for drugs not covered by OHIP+.

This new program would bring a number of changes if adopted. Reflection is therefore necessary as well as a possible review of certain private group benefits plan parameters.

The Normandin Beaudry specialists will continue to monitor any developments relating to OHIP+. They can offer you guidance on the impacts for your organization.

Please feel free to contact us for additional information.