While the Canadian Life and Health Insurance Association is in agreement with the general intent of the Ontario government’s proposed changes to the OHIP+ program, it’s strongly encouraging a number of considerations to preserve the revised program as planned and avoid unintended consequences.

The proposed amendments would roll back the OHIP+ program, which was introduced by the previous Liberal government in January 2018 to cover all OHIP-insured dependants under age 25 for the 4,400 drugs paid for by the province. The change would restrict the free prescription drug coverage program so that it only covers dependants under age 25 who aren’t covered by private plans.

Read: How will OHIP+ rollback affect plan sponsors?

In a letter to the Ministry of Health and Long-Term Care, the CLHIA is urging the government to require employers with existing drug plans for their employees and dependants to continue coverage for dependants under age 25.

“It will be important that the proposed amendments protect against opportunities for employers to remove coverage for Ontario dependants under age 25 years, thereby shifting responsibility to OHIP+. We encourage the government to consider including a requirement within the proposed regulations for employers with existing drug plans to continue providing this coverage to dependants in Ontario.”

The CLHIA is also suggesting the provincial government automate drug claims through the Trillium program. Since the annual deductible is divided into quarters and is paper-based, it’s very complex for patients, insurers and pharmacists to navigate and integrate private benefits with the program, noted the CLHIA in its letter.

Read: Ontario Trillium program sees rise in young users, spend on high-cost drugs

“Prior to OHIP+ being initially implemented in January 2018, ministry staff worked closely with CLHIA and other stakeholders within the drug claim payment stream to automate these claims. Unfortunately, the planned technology improvements to assist with ease of access were not implemented. With the changes to OHIP+ and the potential increased need for Ontarians to access this program, we encourage the government to complete this work. The industry would be happy to work with the government to assist with implementation as needed.”

As well, the CLHIA is encouraging the government to launch general public communications well in advance of implementation to ensure awareness of the proposed changes. And it’s also recommending communications focused on transitioning exceptional access program patients

“We understand that there are challenges with a ministry communication direct to EAP patients but would request that the ministry consider such a communication so that patients are aware of this change, particularly if other clinical requirements are needed,” noted the letter.

Read: What will the transition from private plans to OHIP+ look like?

Copyright © 2021 Transcontinental Media G.P. Originally published on benefitscanada.com

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Dave Patriarche:

Although the CLHIA and myself are often on opposite sides of the fence, Trillium coordination is one area that we agree on 100%. The province was taking all the right steps to help employers have their plans coordinate claim as Trillium had always intended until this came to a halting stop with the election.

If the province wants to avoid huge long-term offloading, then they need to get this process back on track ASAP. Failing to do so will mean that more employers may drop benefits plans and allow the province to be first payor on all claims, rather than just coordinating and covering some of them.

Monday, February 11 at 3:01 pm | Reply

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