OHIP+ has a great premise, but the devil may be in the details.

The program was created so that children and young people under age 25 get free prescription meds. As good as the universal program is in Canada, one area of concern has always been access to medications. A person who needs medical attention gets free access to doctors, emergency rooms, hospital stays, surgery, cancer treatments, etc. Also, when they are in the hospital, their medications are provided. However, as soon as they go home, they need to pay for their own meds (with some exceptions), which some people are unable to do. So, you get the best doctors in the best facilities, but once you leave the doctor’s office, you are on your own.

Until OHIP+ came along in Ontario, that is. Finally kids are covered in Canada’s largest province.

Seems great, right?

Not so fast.

It turns out that the program has two very serious issues that is actually interfering with the healthcare of young people.

First, if a family has a personal supplementary health insurance plan (to top up the things the universal health system does not cover), then they will very likely have difficulties with OHIP+ coverage. If they have a child who needs regular medication, their personal health insurance will no longer cover that medication. The insurers now tell them to get their meds through OHIP+. But OHIP+ may not cover the specific medication that the doctor has been prescribing. OHIP+ has a list of 4,000 or so approved medications, and they release approval to use some of these drugs in order, from cheapest to most expensive. So, if your doctor prescribes a medication, you are required to try the cheapest drugs first to see if those work. If not, OHIP+ will move you up to the more costly drugs.

Consider what that means for a child who is currently being successfully treated with one of the “more expensive” drugs. OHIP+ now requires them to stop taking that drug, thereby risking making them sick (or sicker), in order to experiment on their bodies with a cheaper alternative. If that cheaper alternative does not work, then they can go back to the more expensive drug.

OHIP+ is doing this, despite warnings from physicians that the care of patients is being put at risk. If a doctor prescribes Medication A and knows that it works, OHIP+ is second-guessing the doctor and forcing them to experiment with Medications X, Y, and perhaps Z, to save money. If those don’t work, then the patient can go back to Med A.

As you can imagine, parents are not pleased. Neither are doctors.

For parents, they simply don’t want to put their children at risk of trying different drugs when the current ones are working. They also don’t understand why their personal insurance companies will no longer cover the prescribed medications when their premiums have not gone down. The insurers still charge them for insurance but will no longer pay for meds! Let OHIP+ cover the meds, they say.

The second major issue is with the doctors. To get a child on the more expensive drugs (which actually work), they have to spend hours filling out forms justifying their decisions. Then, to make matters worse, they need to fill out those forms at the beginning of every year, to justify the medications for another 12 month period. So much for trusting doctors to make the best health care decisions!

OHIP+ is still a new program that covers over 3 million young people. We will monitor and let you know if the government finds ways to streamline things for parents in this situation.

For more on this topic, check out this article from CBC. Click to open article …

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