Ontario introduces universal pharmacare for youth 24 and under

This article was originally posted on benefitscanada.com.

Ontario is introducing a pharmacare program for all residents aged 24 and under, Finance Minister Charles Sousa announced today at Queen’s Park as he tabled the 2017 budget.

OHIP+: Children and Youth Pharmacare will launch on January 1, 2018, and will offer universal drug coverage for all medicines listed in the Ontario Drug Benefit formulary. There will be no co-pay or deductible, and youth will be eligible regardless of family income.

“It will decrease plan sponsors’ costs to some extent,” says Tiina Liivet, vice-president of benefits and health at Accompass Inc. She notes dependent children and young workers typically aren’t the biggest contributers of an employer’s drug costs, and the formulary won’t cover several high-cost medications. But the pharmacare program “will still have a mitigating impact on how much [a plan sponsor’s] cost is.”

Read: A primer on some of Canada’s catastrophic drug programs

Liivet also points out the government will be the first payer, so carriers should ensure coordination of benefits occurs in the correct order. Another issue is how high-cost drugs for orphan diseases, currently available to Ontario Drug Benefit recipients through an exception access program, would fit into OHIP+, or how they would coordinate with the province’s Trillium plan.

Earlier this week, the Ontario NDP announced that should they be elected in 2018, they would introduce a universal pharmacare program for all Ontarians, though it would only include 125 essential medicines to start.

Read: What does Ontario NDP pharmacare proposal mean for plan sponsors?

Liivet notes both the Liberal and NDP proposals focus on covering routine drugs while ignoring the high-cost medications that are putting pressure on plan sponsors and insurers. But she isn’t sure if the governments will eventually cover those medicines.

“I don’t know if they’ve got the wallet for them, especially if they’re going to pick up more of these routine costs,” she says. “Where is the money going to come from?”

The budget also includes $73 million to increase publicly funded structured psychotherapy for Ontarians with anxiety, depression and other mental illnesses. It notes it will publicly fund Mifegymiso, the abortion pill Health Canada just approved in July 2015. Alberta and New Brunswick have also committed to publicly funding Mifegymiso.