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OHIP Bulletins


INFOBulletin

Keeping Health Care Providers informed of payment, policy or program changes

Primary Health Care Services InfoBulletins

To: All Primary Care Physicians

Published by:Strategy Execution Branch, Ontario Public Drug Programs, Ministry of Health and Long-Term Care

Date Issued:September 26, 2017

Bulletin Number: 11180

Re: OHIP+ and Medications for Children and Youth

Posted Electronically Only

PDF Version Portable Document Format | 130 kb


As a result of OHIP+, starting January 1, 2018, all children and youth aged 24 and under who are OHIP insured will automatically be covered under the Ontario Drug Benefit (ODB) program.

OHIP+ will ensure that eligible children and youth have no out of pocket costs for all benefits currently covered through the ODB program.  This includes over 4,400 drug products listed on the ODB Formulary/Comparative Drug Index and additional medications eligible for funding through the Exceptional Access Program (EAP).

Children and youth often have very different medical treatment and drug therapy needs from adults.  The ministry is working with clinicians and specialty groups who oversee the medical care of children and youth to ensure there is a smooth transition to OHIP+ on January 1, 2018.

How To Get Ready

Prescribers that specialize in treating children or provide care to children and/or youth are encouraged to familiarize themselves with the kinds of drugs and drug products covered on the ODB Formulary to help patients access medications that are appropriate and covered on January 1, 2018.  You can search the Formulary at:
www.formulary.health.gov.on.ca/formulary/

Exceptional Access Program and OHIP+: Children and Youth Pharmacare

The EAP facilitates publicly funded access for recipients (including all Ontarians age 24 and under who qualify for OHIP+ starting January 1, 2018) in exceptional circumstances to:

  • Drugs not listed on the ODB Formulary;
  • Drugs listed on the ODB Formulary but not for the patient’s indication; or
  • Where ODB Formulary drugs were ineffective, not tolerated or where no listed alternative was available.

To receive coverage for an EAP drug, a funding request must be submitted by the patient’s prescriber with specific information on the patient’s medical circumstance to support funding of the particular drug.  Requests are reviewed on a case-by-case basis and categorized by priority – taking into consideration how quickly a drug is needed, the type of drug, and the condition for which the drug is being used.  If the request is approved, the child or youth will be fully covered for the cost of the medication.

The ministry is planning a streamlined EAP request process for OHIP+ eligible patients who are currently stable on a medication for a chronic condition (whether previously paying out-of-pocket or through private insurance).  The ministry will confirm details regarding this process in the next few weeks.

In order to ensure seamless coverage on January 1, 2018, the ministry is encouraging prescribers to submit EAP requests for eligible patients as soon as possible.  Please feel free to fax full EAP requests to 1-844-227-6590.

What’s new in the OPR?

Updates to the OPR include:

  • Spreading out and enhancing the original two-page record to three pages to allow for more thorough documentation of medical, genetic, and psychosocial issues
  • A total of five pages, including a page of mental health screening resources and a standardized postnatal visit record
  • Consolidation of all lab and ultrasound tests on page 2
  • A comprehensive section on immunizations
  • Prompts for special circumstances requiring time sensitive interventions
  • Inclusion of mental health screening questions and tools
  • Updated genetic history and investigations
  • Updated language respectful of gender identity and the multiple ways in which individuals may identify themselves as a parent
  • Grouped and expanded discussion topics by trimester
  • Updated demographics to reflect newer methods of contact, planned place of birth, newborn care provider
  • A detailed user guide

To order hard copies:

The OPR and user guide can also be downloaded from www.pcmch.on.ca.

What about the Electronic Medical Record (EMR)?

Technical specifications for the electronic version of the OPR are currently under development.  In the meantime, practitioners who use an EMR may want to use the 2017 OPR as a guide to care, while still working within their existing record.

For further details regarding when your EMR will be updated, please contact your vendor.




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.

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