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What Ontario’s changes to OHIP+ tell us about the future of national pharmacare

The first official act of Christine Elliott, Ontario’s new Minister of Health and Long-Term Care, was to announce a fundamental revamp of OHIP+, an initiative of the previous Liberal government to provide prescription drug coverage to everyone under the age of 25.

This is welcome news, for a couple of reasons.

Ensuring that everyone has access to essential prescription drugs is essential; that people cannot afford their medication is a fundamental flaw of Canada’s medicare system.

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But there’s more than one way to skin that cat.

OHIP+, which was seen by many as a catalyst for a broader national program, actually created as many problems as it solved.

It was a politically motivated program designed to generate votes for a desperate government past its “best before” date: At best, well-intentioned but ill-conceived and rushed into existence on Jan. 1.

Many – perhaps most – children and young people in the province already had drug coverage under their parents’ work-related insurance plans. There are also existing public programs for people with disabilities and on social assistance.

Those with private insurance actually had more extensive coverage and in some cases – particularly young people with chronic conditions such as epilepsy, rheumatoid arthritis and cystic fibrosis – they ended up with far worse drug coverage. That’s because the provincial formulary – the list of drugs covered by public insurance – is much smaller than the formulary used by private insurers.

Private insurers, to their credit, said they would continue to provide coverage until July 1 to give the government time to sort out the kinks. These insurers are clearly happy with the change of plans. So, too are many parents and physicians, who were saddled with a lot of extra paperwork and frustration by OHIP+.

Still, there were many positives to the plan. Young people with life-threatening allergies had their EpiPens paid for, youth with mental illness had their psychiatric meds covered and oral contraceptives were made available free-of-charge to young women.

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But, again, these were covered already for those with private insurance.

The news release from the Ministry about OHIP+ did not contain a lot of detail, other than to say it would be more “cost-efficient.”

One thing Ms. Elliott made clear was that the program was not being axed entirely but, rather, the new government would be “focusing benefits on those who do not have existing drug benefits.”

If those with private insurance no longer make claims to the government-run plan, costs will obviously fall substantially for a program estimated to run up to $500-million a year.

(It’s not clear how much OHIP+ cost taxpayers in its first six months, though we know more than one million prescriptions were filled monthly.)

More important than the savings, is how Ms. Elliott has quietly reshaped the debate about national pharmacare.

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There are two principal philosophical camps: One holds that pharmacare should provide first-dollar coverage for all medically necessary prescription drugs for all Canadians; the other argues that public pharmacare should fill in the gaps by providing public coverage to those who do not have private coverage.

So far, the public debate has been dominated by the “first-dollar coverage” camp.

But there’s a new sheriff in town in Ontario and a distinctly more conservative take on what pharmacare should look like.

Let’s not forget, either, that Quebec, the only province with universal pharmacare right now, does not have a first-dollar model.

Rather, drug insurance is mandatory in the province. Large employers must provide it as part of their benefits package, while others (self-employed, unemployed, etc.) must purchase their insurance privately or from the government; those who cannot afford it receive subsidies.

In other words, government monies go to those who do not otherwise have prescription drug insurance.

With both of Canada’s largest provinces preferring this approach, pharmacare is shaping up to look quite different than what many may assume.

The challenge of coming up with the politically palatable formula rests with Eric Hoskins, head of the Advisory Council on the Implementation of National Medicare, and, interestingly, the minister who gave us OHIP+.

Just last week, Dr. Hoskins told a gathering of provincial health ministers that he is examining several different coverage and funding models.

That bodes well.

If Canada truly wants to ensure that everyone has adequate drug coverage, there is going to have to be a willingness to take new approaches, and no small amount of compromise.

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