August 14, 2017
We are pleased to share this update on OHIP+: Children and Youth Pharmacare (OHIP+) with you.
You can count on regular OHIP+ emails like this as your source of ongoing information and updates. We encourage you to share them with staff members, local stakeholders and other clinicians, and colleagues.
The Impact of OHIP+: Children and Youth Pharmacare on Trillium Drug Program (TDP) Households
All Ontarians who are OHIP-insured and are residents of Ontario can register in the TDP if:
· They are not eligible for drug coverage under the Ontario Drug Benefit (ODB) program through another category of recipient (e.g. seniors 65 years of age and older); and,
· Do not have private insurance (or have private insurance which does not cover 100% of prescription drug costs).
The TDP provides ODB coverage to people who are not otherwise eligible for the ODB program and who have high drug costs in relation to their income. The TDP is an income-based program that requires an application and considers the income and drug expenses for all members of a household together. To benefit from the program, households must contribute towards their drug costs through an annual deductible, which is set as a percentage of their household income. There is no upper limit to the cost of drugs that may be reimbursed for an individual recipient; the only limitation is the drug has to be a benefit of the ODB program.
Effective January 1, 2018, all Ontario children and youth aged 24 and under with a health card will be automatically enrolled in OHIP+. This also includes children and youth in TDP households.
What stays the same for TDP households under OHIP+?
Under OHIP+ there will be no change to the household’s annual deductible; for TDP households with members 24 and under, the combined net income of all household members will still be used to calculate the annual deductible.
All household members, including those eligible for OHIP+, will still need to be included on the TDP application form. All household members 16 years of age and older will still be required to sign two declarations in the TDP application form.
What changes for TDP households with members enrolled in OHIP+?
With the implementation of OHIP+ there will be no out-of-pocket expenditures for household members 24 and under to count towards the TDP deductible. Household members 24 and under will receive drug benefits under OHIP+ instead of TDP.
What happens when an individual turns 25?
OHIP+ coverage ends when an individual turns 25. If at that time:
1) An individual is not a member of a TDP household and still requires access to public drug benefit coverage, they can submit an application to TDP; or
2) An individual is still a member of a TDP household, the out-of-pocket TDP-eligible drug expenditures will start to count towards the household deductible. No action will be required to receive TDP benefits.
More Updates Coming
You can expect regular updates like this as we move forward.
Please Stay in Touch
Visit us online at www.ontario.ca/OHIPplus
OHIP+: Information for Professionals: http://www.health.gov.on.ca/en/pro/programs/drugs/ohipplus/
To automatically receive these updates, join our mailing list by emailing OHIPplus@ontario.ca
This document is available in alternate formats upon request.