OHIP+ gets a B-

Before OHIP+ this only cost 12 dollars, thanks to new obstacles it was 72 dollars out of pocket. Photo credit: Jasper Myers

All you need is a health card and a prescription to receive provincial coverage for your meds in Ontario.

While OHIP+, which went into effect January 1, 2018, is meant to make prescription medications more accessible for everyone 24 years and under, the well-intended program has actually created challenges for some people to access their medications.

OHIP+ needs to work better with private insurance companies.

Proposed changes by the Ford government will make it so children and youth 24 years and under who don’t have private insurance will be covered by OHIP+. Those who have private insurance will be billed through their private insurance.

Last year, after OHIP+ began, my private insurance refused to cover my testosterone prescription, citing it should be covered under OHIP+.

And it is — if you’re born male, which I was not, hence the need for the testosterone prescription.

Testosterone is covered by OHIP+ under a Limited Use criteria, shown here. Photo credit: Screenshot from https://www.formulary.health.gov.on.ca/formulary/limitedUseNotes.xhtml?pcg9Id=680800013

In February of last year, my school insurance covered the testosterone after I didn’t qualify for government coverage. Then all of a sudden this year, the insurance refused coverage, citing the doctor needs to apply for exceptional access. This process could take up to six weeks.

I have to get a testosterone shot every week to keep my hormone levels steady, I can’t go six weeks without a shot while I wait to see if the government will cover it.

When I had private insurance, I paid 12 dollars for testosterone. This month, I paid 72 dollars.

Prior to OHIP+ accessing the hormones was no issue, now it’s just hurdle after hurdle.

This is the case for a lot of other medications as well, such as birth control.

There are at least 49 different birth control pills, devices and shots available in Ontario. Website Teen Health Source put together a chart showing which ones are covered, not covered, or covered in special circumstances.

Such circumstances may involve having to prove the particular birth control pill is needed: if a woman has tried other forms that didn’t work, or if she has had adverse effects related to the medication, or if the generic version, many of which are covered by OHIP+, doesn’t work.

Imagine trying medication after medication to treat something, and finally finding the one that works only to have to either repeat this process, or go through a new process just to prove you need it covered.

OHIP+ has created obstacles for accessing medications or, if you’re like me, your drug just isn’t covered for the use you need.

Maybe you have to pay out-of-pocket while you wait for the government to go over an exceptional access application because private insurance won’t cover until OHIP refuses. Or, worst case scenario, you just go without the medication because you can’t afford to pay out-of-pocket while you wait to see who will cover the cost.

The intention behind OHIP+ was genuinely good. The previous government wanted to help improve access to and reduce the cost of medications. But improvements to the program are needed, such as more medications covered and an easier to process to go between private and government funding.

Ford’s changes, making private insurance the first payer for those who have it, is one way to do this.