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Ministry Status: Activation Status

Ontario Public Drug Programs

OHIP+: Children and Youth Pharmacare

For Stakeholders: To make sure as many children and youth as possible benefit from OHIP+, we’ve provided a variety of resources that we encourage you to share with different groups Learn more >>

OHIP+ will provide drug coverage for children and youth who are covered by OHIP and aged 24 and under. OHIP+ begins January 1, 2018.



Who will be covered

All babies, children and youth aged 24 and under who have OHIP coverage will be covered by OHIP+. Enrollment in OHIP+ will be automatic and eligible medications will be covered at no cost. OHIP+ coverage stops on the patient’s 25th birthday.

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How the process works

Patients will not need to apply to the join OHIP+, nor will they need to pay any upfront costs. Those eligible for OHIP+ only need to give pharmacists their health card number and a valid prescription.

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What medications will be covered

OHIP+ will cover all drugs currently available through the Ontario Drug Benefit (ODB) program. This includes more than 4,400 drug products listed on the ODB Formulary/Comparative Drug Index and additional drugs eligible for funding through the Exceptional Access Program (EAP). If a drug is not available through the ODB program, it will not be covered through OHIP+.

Examples of common drug products used by children and youth, which are covered through the ODB program, include:

  • 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

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Exceptional Access Program

The Exceptional Access Program (EAP) provides patients access to drugs not listed on the ODB Formulary, or where no listed alternative is available.

Children and youth with an approved EAP request will be fully covered for the cost of their medications under OHIP+.

For children and youth requiring EAP coverage under OHIP+ who do NOT have an approved EAP request, the ministry is working with clinician groups to facilitate a process to address these requests. The Ministry will provide additional details to clinicians by early fall 2017.

If you have immediate questions or concerns regarding the EAP please contact OHIPplus@ontario.ca.

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Trillium Drug Program

The Trillium Drug Program (TDP) is for people who spend approximately 3 to 4 per cent or more of their after-tax household income on prescription-drug costs. The incomes of TDP household members under age 25 would still be factored into the household deductible calculation. However, any medications funded through OHIP+ would not contribute towards the household’s TDP deductible, as they would not be considered out-of-pocket expenses.

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Private insurance

If the drug is listed on the ODB Formulary, coverage will be provided for this drug through OHIP+.

If the drug is available through the EAP under the ODB Program, children and youth must qualify for coverage of this drug.

If the drug is not currently funded through the ODB program, it will not be funded through OHIP+. Patients and families are being encouraged to speak with prescribers about other treatments which may be covered. Alternatively, this product may be covered by a third party (e.g. private insurance).


OHIP+ for Refugee Claimants

OHIP eligibility is based on immigration status. Convention refugees (those who fear persecution) are eligible for OHIP immediately upon arrival and do not have to wait three months. These children and youth will be covered by OHIP+.

Refugee claimants (those who have not yet received legal status from the government) are not OHIP eligible, but are covered by the federal interim health program while their applications are under review. These children and youth will not be covered by OHIP+.

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Opting out of OHIP+

All Ontario children and youth between the ages of 0-24 will automatically be covered under OHIP+. An individual who does not wish to receive coverage under the program can opt out by contacting: ServiceOntario, INFOline at 1-866-532-3161.

OHIP+: Children and Youth Pharmacare Key Facts for Patients and Families.

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Health care provider access to drug and pharmacy service information

Your drug and pharmacy service information is available to health care providers, in order to provide you with high quality health care. For more information, please visit Ontario.ca/mydruginfo.

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Fact Sheets

OHIP+: Children and Youth Pharmacare Key Facts for Patients and Families [PDF]

OHIP+: Children and Youth Pharmacare Key Facts for Prescribers [PDF]

OHIP+: Children and Youth Pharmacare Key Facts for Pharmacists [PDF]

OHIP+: Children and Youth Pharmacare Exceptional Access Program [PDF]

To view Portable Document Format PDF files, you will need to have Adobe Acrobat® Reader installed on your computer. You can download this free software from the Adobe website.

For More Information

Call ServiceOntario, Infoline at:
1-866-532-3161 (Toll-free)
In Toronto, (416) 314-5518
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282
Hours of operation: Monday to Friday, 8:30am - 5:00pm

 

If you have questions about OHIP+ please contact OHIPplus@ontario.ca.