The new OHIP+ Children and Youth Pharmacare Program now covers 100% of the cost of over 4,400 medications for everyone under 25 years old.
As of January 1, 2018, coverage is automatic, with no enrollment, no upfront costs, no co-payment or annual deductible. All you need is an Ontario health card number and a valid prescription. You must bring your health card with you to the pharmacy.
Who is covered?
You are covered by OHIP+ if you:
- are 24 years and under
- have OHIP coverage
- are not covered by a private plan
You do not have to enroll or register to access OHIP+ coverage.
OHIP+ coverage will stop on your 25th birthday, or if you become covered by a private plan, but you may qualify for other financial help with prescription drug costs.
What drugs are covered under OHIP+?
For those children and youth, OHIP+ covers the cost of more than 4,400 drug products that are currently available through the Ontario Drug Benefit program, including:
- antibiotics to treat infections
- inhalers for asthma
- various insulins, oral diabetic medications and diabetes test strips
- epinephrine auto-injectors (e.g. EPIPENs®)
- drugs to treat arthritis, epilepsy and other chronic conditions
- medications to treat mental health conditions (e.g. antidepressants)
- attention deficit hyperactivity disorder (ADHD) drugs
- drugs to treat some childhood cancers and other rare conditions
- help to quit smoking:
- up to a year of pharmacist-assisted counselling (talk to your pharmacist or health care provider)
- drugs (Champix or Zyban) if you are age 18 years or older
What if the drug is not covered?
If the drug you have been prescribed is not covered by this pharmacare program, there are a number of options to consider. Your Winchester Pharmasave Pharmacist is here to help and can review the following options with you.
Speak to your Doctor/Pharmacist – There may be an alternative medication covered by OHIP+ that is suitable for you.
Private Insurance – If you have private insurance, your drugs are NOT COVERED by OHIP+.
Exceptional Access Program (EAP) – This program may enable access to some medications for which no appropriate alternative is covered by OHIP+. Your Doctor or Nurse Practitioner is required to submit a request on your behalf. If approved, the full cost of the medication will be covered. Visit ontario.ca/page/applying-exceptional-access-program
How OHIP+ affects other coverage
If you have a private plan you are not eligible for OHIP+.
Trillium Drug Program
If you have coverage through a private plan, but your household still has significant out-of-pocket costs, you can apply for additional financial support through the Trillium Drug Program.
Ontario Works, Ontario Disability Support Program, Long-Term Care, Home Care, Homes for Special Care, Community Homes for Opportunity
If you are enrolled in the Ontario Drug Benefit program through other eligibility criteria (Ontario Works, the Ontario Disability Support Program, Long-Term Care, Home Care, Homes for Special Care, or Community Homes for Opportunity), regardless of whether you are covered by a private plan, and need a covered medication:
- Visit your doctor or nurse practitioner and get your prescription.
- Take your health card OR health card number to any pharmacy in Ontario – you don’t need a separate or special card.
- The pharmacy will fill your prescription at no charge.
If you have any questions about OHIP+ and your drug coverage, your Pharmacist is here to help. Want more information?
• For general OHIP+ questions or comments, email: OHIPplus@ontario.ca
• To learn more about OHIP+, visit: ontario.ca/page/learn-about-ohip-plus
• To learn more about the Ontario Drug Benefit program, visit: ontario.ca/drugbenefit