Changes to Ontario drug program a (very small) step forward

Around this same time last year, I wrote about why the creation of OHIP+, a new program to provide “free” prescription drugs for Ontarians under 25, was misguided. The province already had an existing program (Trillium) designed to target funding to people whose prescription drug costs impose the largest personal financial burden. The new OHIP+ program would do little for those in legitimate need while expanding coverage (and divert scarce resources) to families that don’t need financial help.

It seems Premier Doug Ford’s newly-minted government agrees. In a bold move, just a day after being sworn in, the province’s new health minister (Christine Elliott) announced the government will amend OHIP+ so it caters only to children and youth not already covered by private plans. For those who are, the government would cover any remaining eligible prescription costs not covered by their private plans (which would be billed first).

While these changes were primarily brought in with the intention of “saving the taxpayers money,” they also tacitly acknowledge the flaws of OHIP+, which covered fewer and older medicines than covered by private insurers—and reportedly also increased bureaucratic inefficiency.

Of course, the real problem with OHIP+ in its initial incarnation was that it was an unnecessary program that provided limited coverage to a population that largely didn’t need assistance.

For example, young adults 18 to 25 who needed assistance most were already eligible for coverage under pre-existing plans (after paying a deductible based on income).

As for children under the age of 18? They never really had to pay for drugs in the first place. Rather, their parents or caregivers did. Again, an income-based means-tested approach (such as the existing Trillium plan) would help make sure scarce resources and hard-earned taxpayer dollars flowed to families in greatest need.

Of course, there’s evidence to suggest many patients still struggle to pay for their prescription medication. However, instead of creating another arbitrary age-based plan, the answer should have been to amend existing programs to better identify and target those patients with the greatest financial need, chronic conditions and disabilities. Alternatively, the government could have made it easier for individuals to claim expenses under Trillium or re-examine the minimum deductibles for the lowest-income earners.

The changes announced by the Ford government neither fully address the fundamental flaws with OHIP+ nor do they offer remedies for any potential deficiencies with existing programs. However, they are a small step in the right direction—acknowledging the flaws of the previous government’s misguided initiative, and understanding the important part private insurers play in the provision of drug insurance.