The new Conservative government in Ontario hasn’t wasted any time announcing changes to the previous government’s OHIP+ drug program for children. Even though this means slightly higher costs for companies, I think that this change is better for employees.
Firstly, due to rushed implementation, coordination was an issue for many employees, especially when it came to drugs that fell under the OHIP+ Exceptional Access Program (EAP). For these claims, employees were often left paying the full amount out of pocket until their EAP paperwork, which included physician recommendations, was completed, reviewed, and approved.
Secondly, the number of drugs that require EAP approval is relatively small, but it does include several alternative forms of medications that are prescribed to children. This caused confusion for employees, many of whom became upset with their employers and insurers as a result. The new program eliminates this issue.
The OHIP+ program sounded great for employers, but when you look at the low volume and cost associated with claims for the covered medications, the savings are not significant, and the issues related to the EAP caused more issues for employers than the savings were worth.
While the implementation date is not yet known, the change that will impact members and sponsors of private plans most is that OHIP+ will now only provide payment if a private plan doesn’t. This means that the small savings that employers were hoping to get from this program won’t have time to materialize.