OHIP+: Children and Youth Pharmacare – How OHIP+ Will Make A Difference For You

OHIP+: Children and Youth Pharmacare – How OHIP+ Will Make A Difference For You

Beginning January 1, 2018, the province will provide drug coverage for children and youth who are covered by OHIP and aged 24 and under, regardless of family income. For many youth and families, this is an exciting prospect for those who require medications and therapies not currently covered by OHIP.

OHIP+: Children and Youth Pharmacare - How OHIP+ Will Make A Difference For You

OHIP+ will create a new class of eligible recipients under the Ontario Drug Benefit (ODB) program, which includes medications eligible for funding through the Exceptional Access Program (EAP). We’ve rounded up the pertinent information about this new OHIP+ program and what it might mean to you.

Do I Need To Apply For OHIP+?

Infants, children, and youth aged 24 and under who have OHIP coverage will be covered by OHIP+. Essentially, enrolment in OHIP+ will be automatic and the specified medications will be covered at no cost.

OHIP+ coverage continues until the patient turns 25.

Patients do not need to pay any upfront costs. Those eligible for OHIP+ (residents of Ontario with a valid, up-to-date Ontario Health Card) only need to give their pharmacist a health card number and valid prescription to receive their medication at no cost.

What Drugs Are Covered Through OHIP+?

OHIP+ covers all drugs available through the  Ontario Drug Benefit (ODB) program, which includes over 4,400 drug products. You can search the full list of drugs using the ODB Formulary/Comparative Drug Index. Many common drug products used by people 24 and under include but are not limited to:

‌• Antibiotics to treat infections

 ‌• Inhalers for asthma

 ‌• Various insulins, oral diabetic medications and diabetes test strips

 ‌• Antidepressants

 ‌• Oral contraceptives

 ‌• Epilepsy drugs

 ‌• Medications to treat mental health conditions

 ‌• Attention deficit hyperactivity disorder (ADHD) drugs

 ‌• Some drugs to treat childhood cancers and other rare conditions

It’s very important to talk with your health care professionals and work within the ODB program to ensure the medication prescribed is covered.

What Is The Exceptional Access Program?

If the drug product you or your child require is not covered within the ODB program, then the Exceptional Access Program (EAP) is another program that may help you get the medications you need.  

The EAP program requires an application, and you must receive a prescription from a licensed medical professional.

EAP request forms have been developed for, but not limited to, the medications listed below.

 ‌•Alcohol Addiction Therapy (acamprosate, naltrexone)

‌ • Alfacalcidol (drops)

 ‌• Atomoxetine

 ‌• Betahistine

 ‌• Buspirone

 ‌• Hormone Therapy (conjugated estrogen, estradiol, progesterone, testosterone)

 ‌• Modafinil

 ‌• Oxcarbazepine

 ‌• Phytonadione & Multivitamin (injections)

 ‌• Tranexamic acid

‌• Valacyclovir

Needless to say, OHIP+ and the EAP can be a significant resource for those children, youth, and families who require medications and therapies not previously covered by OHIP.

For more information visit the Ontario Ministry of Health and Long Term Care.

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