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Ministry Status: Routine Monitoring and Engagement

OHIP+: Children and Youth Pharmacare

OHIP+ Stakeholder E–blast

Patients First

Update: OHIP+ Children and Youth Pharmacare Program

August 28, 2017


We are pleased to share this update on OHIP+: Children and Youth Pharmacare Program (OHIP+) with you.

You can count on regular OHIP+ emails like this as your source of ongoing information and updates. We encourage you to share them with staff members, local stakeholders and other clinicians, and colleagues.

Implementation Updates for OHIP+: Children and Youth Pharmacare

As part of Budget 2017, the government announced its intention to create and implement "OHIP+: Children and Youth Pharmacare" (OHIP+) by January 1, 2018. OHIP+ would provide universal drug coverage to approximately 4.1 million children and youth across Ontario aged 24 and under.

Over the course of the summer/fall, the ministry is meeting with key stakeholders, including patient groups, prescribers, pharmacists, pharmaceutical manufacturers, private insurance industry, and others to ensure different perspectives are reflected as we plan for implementation of OHIP+.

Feedback Regarding OHIIP+

Initial meetings with key stakeholders and feedback from the Regulatory Registry posting (which closed on August 10) have been positive. The ministry is appreciative of the continued interest in OHIP+ and the valuable feedback that we have been receiving.

The ministry is working closely with clinicians and other stakeholder groups to respond to feedback and potential concerns raised regarding OHIP+ including:

  1. Ensuring Appropriateness of the Formulary for Children and Youth

    Most drugs funded under the Ontario Drug Benefit (ODB) program are listed on the Formulary/Comparative Drug Index (Formulary). The ODB program provides coverage to over 4,400 drug products for approximately 3.9 million Ontarians, including over 2.2M seniors. Currently, eligible Ontarians include:

    • Seniors (those 65 years of age or older);
    • People on social assistance;
    • People residing in homes for special care or long-term care homes;
    • People receiving professional home care services; and,
    • Registrants in the Trillium Drug Program (TDP). 
    • Under OHIP+, children and youth aged 24 and under who are OHIP insured would be added as an eligible class of ODB recipients

    Through the feedback received, some clinicians have noted that the ministry should use this opportunity to review the medicines captured on the Formulary from a pediatric/youth perspective. For example, ensuring that medications are available in appropriate dosage forms for children, such as liquid. It has also been suggested that the ministry work with clinicians to enhance appropriate prescribing for paediatric populations; helping to identify both appropriate and inappropriate medications.

    The ministry appreciates this feedback and is committed to continuing to work with clinicians to ensure that Formulary products are available in appropriate forms and to enhance appropriate prescribing.

  2. Collaboration with Private Insurance to Ensure Seamless Coverage for Children and Youth

    The government is working with representatives from the private insurance industry to ensure that individuals currently covered through private insurance, including individuals who may be taking a drug eligible for funding through the Exceptional Access Program*, smoothly transition to coverage through OHIP+ on January 1, 2018. The government and private insurance industry are committed to ensuring that Ontarian children and youth receive the best patient care and experience, and that drug coverage is not interrupted due to the implementation of OHIP+.

    * To receive access to an Exceptional Access Program drug, a funding request must be submitted by the patient’s prescriber with specific information on the patient’s medical circumstance to support funding of the particular drug. Requests are reviewed on a case-by-case basis and are categorized in order of priority – how quickly a drug is needed, the type of drug, and the condition for which the drug is being used. If the request is approved, the child or youth will be fully covered for the cost of their medication

  3. Exceptional Access Program Pre-Approvals

    The ministry has heard the concerns raised by clinicians regarding the time and effort required to complete Exceptional Access Program requests for all of their patients under 25 who may be taking a drug eligible for funding through this program by January 1, 2018.  In addition to working with the private insurance industry to assess and potentially transition children/youth that require Exceptional Access Program medications, the ministry is developing a streamlined Exceptional Access Program pre-approvals process for children and youth. Further details will be available in the fall regarding Exceptional Access Program pre-approvals.

    More details will continue to be provided regarding OHIP+. We welcome any comments, feedback or advice that you may have regarding OHIP+ and its implementation.

More Updates Coming

You can expect regular updates like this as we move forward.

Please Stay in Touch

Visit us online at www.ontario.ca/OHIPplus

OHIP+: Information for Professionals

To automatically receive these updates, join our mailing list by emailing OHIPplus@ontario.ca

This document is available in alternate formats upon request.

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