Ontario government to become second payer under OHIP+ changes

Ontario’s new Conservative government has announced changes to the province’s youth pharmacare program to make it second payer for Ontarians under age 25 who have coverage through private benefits plans.

“Today, our government is announcing our intent to fix the OHIP+ program by focusing benefits on those who do not have existing prescription drug benefits,” said Christine Elliott, minister of health and long-term care, in a statement.

“Children and youth who are not covered by private benefits would continue to receive their eligible prescriptions for free. Those who are covered by private plans would bill those plans first, with the government covering all remaining eligible costs of prescriptions.”

Elliott said the new system will be more efficient, save taxpayers money and dedicate resources to those most in need. “Even more importantly, it would continue to guarantee that children and youth still receive the prescription drugs they need.”

In a statement, the Canadian Life and Health Insurance Association said it welcomed the changes to the youth pharmacare program, which only took effect on Jan. 1, 2018.

“The life and health insurance industry is committed to working with the government of Ontario to ensure a smooth transition and is pleased to extend the transition period agreed to with the previous government beyond July 1,” said Stephen Frank, president and chief executive officer of the CLHIA.

“We will work closely with the new government to ensure that all those who are eligible for coverage under an employer-sponsored health benefit plan are transitioned back from the OHIP+ children and youth pharmacare program with minimal disruption.”

When it comes to the impact on employers and plan sponsors, Christiane Bourassa, a senior consultant at Willis Towers Watson, says the costs they had been saving as a result of the youth pharmacare program will now revert back to them.

“Based on what they had budgeted, based on what they knew of the program, then obviously it’s going to cost them more because some of the costs will revert back to employers,” says Bourassa.

She doesn’t, however, believe the latest changes will have a major impact as children are typically not the biggest consumers of drugs. “I don’t want to say it’s a minor cost . . . but as much as the introduction of OHIP+ had generated savings, then those savings are just vanishing. So it has an impact — not a very large impact but it’s still an impact,” she says.

Ryan Murphy | Benefits Canada ~ July 3, 2018

2018-07-12T22:01:36+00:00