This article was published before the transition to the new Plan Administrator, Canada Life. If you have any questions, contact the PSHCP Member Contact Centre at 1-855-415-4414 (toll-free anywhere in North America) or 1-431-489-4064 (call collect if you are outside North America).
As part of the 2017 Budget, Ontario has announced that it will make prescription medications free for all children and youth 24 years of age and younger, regardless of family income or student status. Under Ontario’s new OHIP+: Children and Youth Pharmacare Program, coverage for prescription medications will be automatic with no upfront costs if they are listed on the Ontario Drug Benefit Formulary/Comprehensive Drug Index or if they are funded through the Exceptional Access Program.
The proposed program, which will come into effect January 1, 2018, will improve access to prescription medications for more than four million children and young people in Ontario, including students and young professionals who may not have access to comprehensive drug benefit plans as they pursue postsecondary education or begin their careers. No application is needed to enrol in the program. OHIP+ claims will be submitted by Ontario pharmacies and adjudicated online using the individual’s OHIP card.
OHIP+ will give young people access to more than 4,400 drugs reimbursed under the Ontario Drug Benefit Program (ODB), including:
- Full coverage of ODB general formulary medication;
- “Limited use” drugs, which are drugs under the program that are reimbursed only when specific and pre-defined medical criteria are met, as determined by the prescribing physician;
- Drugs under the ODB Exceptional Access Program (EAP), which include the majority of high-cost drugs. A doctor is required to initiate an EAP request, similar to those under Sun Life’s Prior Authorization program. The Ontario Ministry of Health and Long Term Care (MOHLTC) evaluates each request on a case-by-case basis.
- *Ontario members and dependants under 24 taking a drug eligible for funding through EAP will need to apply for the Ontario Drug Benefit for coverage of the EAP drug.
As of January 1, 2018, drug claims for eligible participants under the OHIP+ program must first be submitted to OHIP before they are submitted to the PSHCP.
Please note that out-of-country and out-of-province claims are not eligible for coverage under the OHIP+ program and will continue to be reimbursed by private plans, subject to plan eligibility.
For more information on OHIP+, please click here.