Starting April 1, 2019, the Government of Ontario is changing OHIP+ by focusing benefits on those without private plans. For additional details, click here for the Ministry of Health and Long Term Care bulletin (dated Feb. 27, 2019).

It is important to understand how these changes affect OHIP-insured children and youth under the age of 25 years, including those:

Without a private plan, who will remain automatically enrolled in OHIP+
With a private plan, who will no longer be eligible for OHIP+ and will access prescribed medicines through your private plan

For those without private medication insurance, OHIP+ will continue to cover the cost of more than 4,400 drug products that are currently available through the Ontario Drug Benefit program.

It is important to understand that if you have a private insurance plan, your child’s medications will no longer be covered by OHIP+ and you will access your child’s prescribed medications as you did before the launch of OHIP+. You may have to pay out-of-pocket for your child’s medication. Please let you child’s social worker, nurse, pharmacist or doctor know if this will be a burden on your family. Contact your private insurer to learn more about your coverage plan.

Here is what you need to do to minimize disruptions and delays your child’s prescription medication coverage:
Option A: For those without private medication insurance

For those without private insurance, check online to see if your child’s medication is automatically covered by OHIP+.

If your child’s medication is designated as “covered,” you do not need to proceed to Option C. If any of your child’s medications are designated as “may be covered” or “not covered,” proceed to Option C.
Option B: For those with private insurance (e.g. from your employer)

If you have private medication insurance, such as Greenshield or Sun Life, your child’s medication – whether or not the insurance covers the particular medication – will no longer be covered by OHIP+. Contact your private insurer to learn more about your coverage plan.

If your child’s medications will not be covered by your private insurer, proceed to Option C.
Option C: Alternate sources of funding for those with or without private insurance

Members of your health-care team may be able to assist with identifying alternate sources of funding if medication costs will be a burden to your family. Please contact your child’s doctor, nurse, pharmacist or social worker if you meet one or more of the following conditions:

If you do not have private medication insurance, and your child’s medication will not be automatically covered by OHIP+
If you have private medication insurance, but it will provide insufficient coverage for your child’s medication

The Resource Navigation Service (RNS) at SickKids can assist families in contacting their private health insurers as well as explaining and assisting families with their Trillium Drug Program applications. The RNS is located in the Social Work Department and appointments can be requested by families or team members via [email protected].

If you have any questions or concerns about your child’s medication coverage, please speak to a member of your child’s health-care team at SickKids.

You can also reach out to the Government of Ontario at [email protected].

source: media release, Sick Kids Hospital