The new OHIP+ program is set to help millions of Ontarians under 25 access thousands of free prescription drugs, but it’s having unintended consequences for some who were already privately insured.
One pharmacist tells CityNews that because only certain drugs are covered under the new program, it’s creating delays for patients while the pharmacies sort out who is paying.
“A lot of insurance companies are saying ‘bill the government first’, and refusing the drug claim,” says Dr. Michael Fanous, a pharmacist with Medsexperts.ca. “So now, we have to show proof that the government doesn’t cover this drug in order for them to cover it, and it’s adding extra time and energy for someone to access treatment they were just on last month.”
Dr. Fanous says the other issue is that some patients who were successfully using a specific drug or brand name, may now have to switch to another one approved by OHIP+, which could impact their health.
“We know switching brands sometimes has different pharmacokinetics, different ways the drug works in the body,” says Dr. Fanous. He says there is a way to request coverage from the government for a drug that isn’t one of the 4,400, mostly generic brands, on the approved list, but it can be a timely process.
“They would first have to take it (the approved brand) to satisfy the government requirement, and the doctor would have to write in to the Ministry of Health saying they can’t tolerate this brand in order to access the brand name medication,” explains Dr. Fanous.
“The whole process can take months.”
In a statement to CityNews, the Ministry of Health says there’s an established process for determining which drug products are funded under the ministry’s public drug programs.
“The government is working with representatives from the private insurance industry to ensure that individuals currently covered through private insurance, including individuals who may be taking a drug eligible for funding through the Exceptional Access Program (EAP), smoothly transition to coverage through OHIP+.”