By REBECCA SOARES
For many, the new OHIP + program seems to be a blessing with few downsides. However, according to pharmacists in the region, this isn’t necessarily the case.
“At first glance it seems like a great idea for most people, but when you look into it, most people 24 and under are covered under their parents’ health benefits,” said Ayman Labib, pharmacist at Lang’s Medical Pharmacy. “The parents are paying to keep them under the health plan that their kids can no longer use. All medications are forced to go through government coverage first and the plans will refuse to pay unless it’s not covered by the government.”
Parents are paying a premium for their insurance plans based on the members in the family who are on the drug plan, yet with the newly introduced OHIP+ parents are still paying insurance companies the same premium even though it’s now the government covering the cost of their children’s medications.
Insurance companies greatly benefit from this while the government and residents of Canada suffer from the loss this causes.
Taxpayers are paying the government to enable them to cover the expenses of OHIP+ regardless if they need the insurance or not. Unfortunately, this isn’t a matter that can be solved at the pharmacy level either. By law, pharmacies are required to bill the government before any private insurance plans. This ultimately wastes the money parents are paying toward their premiums and taxpayers’ money as well, as they are helping pay for the cost of every child’s medications, regardless if they need the plan or not.
“A simple solution would be for government to implement that the private plans have to be billed first and if it’s covered by private insurance plans, OHIP+ doesn’t have to be used. However, if the medication isn’t covered or the kids don’t have a private plan then the medication can be paid for with the OHIP+ program,” said Labib.
The issues surrounding OHIP+ don’t end there either.
Certain medications require a specific code from the doctor in order for the medication to be covered by the government.
“Private insurances don’t require any code to cover medications so parents and young adults are suddenly told this by pharmacies when they try to fill their medications. It wouldn’t be an issue but they weren’t told, so they come to get their medications because they’ve run out and they have to wait even longer because now we have to get ahold of their doctors. It’s creating a lot of headaches. It would be worth it if these people 24 and under really needed this plan but they don’t. The majority of those eligible for OHIP + don’t need it,” said Labib.
While that issue will slowly resolve itself over time, there are medications that are not covered by OHIP+ that private insurance plans normally pay for. Formerly the Ontario Drug Benefit program (ODB) covered a variety of medications but there were some exceptions such as vertigo medications, migraine medications, sleeping aids, etc. Those medications are only covered in rare exceptions by the government yet they are always covered by private insurances.
Yet due to the immense billing complications, private insurances are becoming increasingly more difficult to get medications from. As long as the government has to be billed first by law, insurance companies will continue to deny medication coverage for those 24 and under.
“Essentially, by law, pharmacies have to use taxpayer money to cover the cost of medications while all the insurance plans don’t have to pay anymore. OHIP+ is a way for insurance plans to get richer while doing nothing,” said Labib.
However, it’s not just a matter of those 24 and under are already covered. Pharmacist Ben Atekha at Food Basics pharmacy believes individuals with dire health needs would be better suited for medications covered by the government.
“When you’re that age, 24 or younger, most people are the healthiest they’ve ever been. The notion of the government being willing to help assist those is a good idea, it would just be more effective for those who really need it. They’re putting money into something people don’t need. They should be focusing on those who require life-maintenance medications like diabetics. There’s rarely an issue of coverage for those 24 and under, it’s a bigger issue for people from ages 25-64. When you’re 65 and over, you get coverage and that’s beneficial. But to be giving healthy people this opportunity is just an attempt to make the government look good, while people are just trying to manage their life with medications are still struggling,” said Atekha.
Individuals between the ages of 25-64 aren’t assisted by any government plan, and if their work doesn’t have any benefits it can be difficult for them to come up with the money to pay for necessary medications.
OHIP+ could have had the potential to become an incredibly useful resource, but the flaws within the system leaves a lot to be desired.