OHIP+: Ontario Drug Coverage for Anyone < 25 Years of Age

January 1st brought about some major change to the Ontario Government's Drug Benefit Plan.  Below is a summary of the new OHIP+ plan and what it means for families.  It has been adapted straight from the Ontario.ca online explanation.

Learn about OHIP+

Starting January 1, 2018, more than 4,400 drug products are free for anyone age 24 years or younger. You don’t need to enroll – all you need is a health card number and an eligible prescription.

Who is covered

All babies, children and youth age 24 years and under who have OHIP coverage are automatically covered by OHIP+: Children and Youth Pharmacare.

You do not have to enroll or register to access OHIP+ – coverage is automatic.

OHIP+ coverage will stop on your 25th birthday, but you may qualify for other financial help with prescription drug costs.

What is covered

OHIP+ completely 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

Medications available through the Exceptional Access Program may also be covered if an individual qualifies.

How to get your medication

If you’re a parent

If your child is 24 years old or under and needs a covered medication:

  1. Visit your child’s doctor or nurse practitioner and get their prescription.

  2. Take their health card OR health card number to any pharmacy in Ontario – you don’t need a separate or special card.

  3. The pharmacy will fill their prescription at no charge – you don’t pay a dispensing fee, deductible or co-payment.

If you’re 24 years old or under

If you need a covered medication:

  1. Visit your doctor or nurse practitioner and get your prescription.

  2. Take your health card OR health card number to any pharmacy in Ontario – you don’t need a separate or special card.

  3. The pharmacy will fill your prescription at no charge – you don’t pay a dispensing fee, deductible or co-payment.

How OHIP+ affects other coverage

Insurance plans

If you have a child eligible for OHIP+, as of January 1, 2018, OHIP+ is the first payer for eligible drug products.

Trillium Drug Program members

If your child is age 24 or under and a member of a Trillium Drug Program household, as of January 1, 2018 they are covered through OHIP+. This means, because you don’t pay out-of-pocket for their medications, no money from those medications counts toward your deductible.

Students going to university/college in another province

If you’re going to university or college in another province, your prescriptions may still be covered by OHIP+ if you:

  • remain insured by OHIP

  • have a valid prescription

  • get your medications from a pharmacy in Ontario

You may be able to get a larger “travel supply” of your medication before leaving Ontario.

Dan Yurchuk