What is OHIP+: Children and Youth Pharmacare
Under OHIP+, prescription drugs listed on the Ontario Drug Benefit formulary will be free for
Ontarians aged 24 and under, starting on January 1, 2018. Their eligibility will be guaranteed when
they present a prescription and a valid Ontario health card, and no deductible or co-payment will be
charged. Drugs eligible for funding through the Exceptional Access Program may also be covered
under the same terms and conditions, on request, with the approval of the Ontario Ministry of Health
and Long-Term Care (for more information, see the Drugs eligible for funding through the
Exceptional Access Program section below).
How does it work with your work insurance coverage?
As is currently the case with other public plans in Ontario and across Canada, OHIP+ will become the
first payer for the patients and drugs it covers in the province. Insureds who incur expenses for drugs
that aren’t covered or that are rejected by the public plan will be able to submit them to their group
insurance plan and be reimbursed based on their plan’s terms and conditions, which remain the same.
What medications will be covered
OHIP+ will completely cover the cost of more than 4,400 drug products that are currently available through the Ontario Drug Benefit program, including:
- antibiotics to treat infections
- inhalers for asthma
- various insulins, oral diabetic medications and diabetes test strips
- epinephrine auto-injectors (e.g. EPIPENs®)
- drugs to treat arthritis, epilepsy and other chronic conditions
- medications to treat mental health conditions (e.g. antidepressants)
- attention deficit hyperactivity disorder (ADHD) drugs
- drugs to treat some childhood cancers and other rare conditions
Drugs eligible for funding through the Exceptional Access Program
Certain drugs not listed on the Ontario Drug Benefit formulary may still be covered by the public plan
if they are eligible for funding through the Ontario Ministry of Health and Long-Term Care’s
Exceptional Access Program (EAP). Insureds who take drugs that fall into this category will have to ask
their attending physician to submit a request to the Ministry. The Ministry will then determine if the
coverage can be granted.
Who will be covered
All babies, children and youth age 24 years and under who have OHIP coverage will be automatically covered by OHIP+: Children and Youth Pharmacare.
You do not have to enroll or register to access OHIP+ – coverage is automatic.
OHIP+ coverage will stop on your 25th birthday, but you may qualify for other financial help with prescription drug costs.
If you have questions about OHIP coverage or your group benefits/work health and dental insurance please contact Andrew by email – firstname.lastname@example.org or call 613-286-6841.