Free prescriptions for many children, young adults in Ontario set to end in March

Yorkregion.com
January 7, 2019
Rob Ferguson

Free taxpayer-funded prescriptions to children and young adults under 25 will end in March if they have private insurance coverage.

The looming change in the OHIP+ pharmacare program, expected to save $250 million a year, was first announced in late June as Premier Doug Ford’s Progressive Conservatives took power but the time frame for implementation remained a mystery until now.

“The government is fixing OHIP+ by focusing benefits on those who need them the most,” said a notice posted online on a government website this week putting the proposal out for public comment until the end of January.

Sources said the government hopes to have the necessary systems in place with insurers and pharmacies by late March.

Under the new plan, children and young adults will continue to get free prescriptions if they or their parents do not have private health insurance coverage.

Otherwise, private insurance plans become the “first payer” for prescription medicines.

At issue is how pharmacists will be able to verify whether customers under 25 have private coverage, or deductibles or co-payments.

The Ontario Pharmacists Association said it supports the initiative and is eager to have a smooth, streamlined process to make sure children and young adults get the medicines they need without snags.

“There’s still some technical issues and IT system issues to work out,” Allen Malek, the association’s executive vice-president and chief pharmacy officer, told the Star on Friday.

At drug stores, pharmacists will ask customers if they have insurance and check their coverage online. But pharmacists are concerned about the complications of performing a “policing” function on behalf of the government.

“It puts us at a risk we cannot necessarily protect against,” said Malek, concerned some customers, whose insurance plans require them to cover some of their drug costs through copays or deductibles, may say they do not have insurance to avoid paying anything.

The association is concerned the government will make pharmacies liable for the costs if it’s later discovered the customer had private insurance.

Health Minister Christine Elliott’s office would not specify how the system would be made fail-safe, other than to say “our government is broadly engaging with employers, pharmacies and insurance companies as part of our efforts to ensure a smooth transition and implementation.”

New Democrat MPP and health critic France Gelinas (Nickel Belt) said the change will be more costly to administer and prone to complications.

“This patchwork system is the most likely to have big cracks for people to fall through, especially since, right now, the government has no sure way to figure out which children have or have not been put back on their parents’ private insurance plans.”

The Green party questioned the promised cost savings, saying Finance Minister Vic Fedeli has put them as low as $100 million and as high as $300 million at different times.

“They have been playing fast and loose with the numbers,” said a statement from the office of Green Leader Mike Schreiner, MPP for Guelph.

About 4,400 medications are eligible under the pharmacare plan launched a year ago by the previous Liberal government.

In his fall economic statement, Fedeli estimated the move will save “at least” $250 million.

“The government promised that it would find efficiencies while ensuring that vital public services are affordable and sustainable, now and in the years to come,” he wrote.

Ford has promised to find $6 billion in annual spending cuts in a bid to eliminate a provincial deficit the government pegs at $14.5 billion.

Drugs covered under OHIP+ are the same ones used in the Ontario Drug Benefit Program for seniors and people on social assistance.