Ontario’s universal drug program: back to square one

Last year, we informed you that Ontario would offer a free universal drug program, OHIP+, to children and youth under the age of 25. This plan came into effect on January 1, 2018.

On June 30, Ontario’s new Minister of Health and Long-Term Care, Christine Elliott, announced major changes to OHIP+. The new Conservative government wishes to revamp the plan and become a second payer for all Ontarians under the age of 25 with access to a private insurance plan. Not many details about the government’s intentions are known at this time, but we believe that this modification could come into effect shortly.

Private insurers, which had provided the government with a transition period until July 1, 2018 for several drugs prior to being transferred to OHIP+ (mainly for expensive drugs with prior authorization), will be called on to contribute further by extending the transition period, possibly until these drugs are once again reimbursed under private plans.

Many questions remain:

• Will the Ontario government push private plans to provide minimum coverage for those under the age of 25, as is the case with Quebec’s basic prescription drug insurance plan?
• Will the government’s second payer role fall under OHIP+’s current reimbursement criteria?
• Could private plans be adjusted to avoid taking over responsibility of OHIP+ beneficiaries?

In essence, this is a change of course for the Ontario government, which appears to be more concerned about addressing the province’s drug insurance deficiencies rather than offering a universal drug program.

In our first bulletin on this topic, we proposed a three-pronged reflective approach for private plan sponsors focused on:

• pricing,
• eligibility of dependants, and
• the list of drugs covered.

Organizations that modified those orientations will have to re-assess their position once details of the modifications become available.

For additional information, feel free to contact Normandin Beaudry’s consultants