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OHIP+: Children and Youth Pharmacare starting January 1, 2018

By Sunnybrook Academic Family Health Team  •  November 29, 2017

As you may have heard in the news, as of January 1, 2018, all children and youth aged 24 and under with OHIP coverage will have prescription drug coverage. The program will operate very similarly to ODB for seniors, except there will be no deductible or copays.

Key points about OHIP+:

  • Same formulary as ODB (includes coverage for oral contraceptives, some ADHD drugs, some epilepsy meds, etc)
  • LU codes will be required for coverage for some meds
  • Patients will be eligible for the exceptional access program, so you may apply for coverage for drugs not on the formulary
  • Coverage will terminate on the patient’s 25th birthday

All eligible patients will be automatically enrolled in the program. Pharmacies will need to collect the patient’s health card number in order to process prescriptions through the program (currently, this information is not routinely collected), so if you document the OHIP number on the prescriptions, it will make the process go more smoothly, but you are not required to do so.

For patients that have private drug coverage, if a drug is covered by OHIP+, it will no longer be paid for by the private insurance (as the insurance companies will know that the patient should be covered by OHIP+). If a drug is not on the ODB formulary, private insurance should continue to cover it.

Patients may choose to opt-out of the program by contacting ServiceOntario, INFOline at 1-866-532-3161.

Learn more about OHIP+