Ontario Health Insurance Plan Plus or OHIP+
What is OHIP+?
On January 1, 2018, Ontario Health Insurance Plan+ (OHIP+) begins. More that 4,400 eligible prescription drug products will be covered by OHIP+ at no cost for children and youth aged 24 and under, who are covered by the Ontario Health Insurance Plan (OHIP). Enrollment in OHIP+ is automatic and coverage stops on the individual’s 25th birthday.
How does OHIP+ Work?
If the drug is listed on the Ontario Drug Benefit (ODB) Formulary/Comparative Drug Index and an individual is eligible for OHIP+, prescriptions will be dispensed with no out of pocket expense for an eligible individual at the pharmacy. All that is required at the pharmacy is a health card number and an eligible prescription.
Exceptional Access Program (EAP)
Not all drugs are eligible through OHIP+ unless certain qualifying conditions are satisfied. In this case, an individual must submit a request for EAP funding. The EAP facilitates access to drugs not listed on the ODB formulary under specific clinical circumstances.
The application and approval process through the EAP can take anywhere between 3 days to 6 weeks, depending on the individual’s medical circumstances and the particular drug involved. While an individual’s file is under review with the EAP, and if the drug had previously been eligible under the individual’s private group plan, the various insurance providers have made the decision to continue honouring a claimant’s drug expenses during the approval process through the EAP. Insurance providers have different guidelines relating to this process and ASSOCIUM can help you determine how your provider will be integrating between the two programs.
Applying to the Exceptional Access Program
Get help paying for drugs not covered by the Ontario Drug Benefit. Learn how to qualify and apply.
Find out who’s eligible, what medications are covered and how to get them.