Children and youth up to age of 25 are eligible for free prescriptions under OHIP+

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Having no private coverage for prescriptions might add extra stress when your child or teen falls ill and requires medication.  Fortunately, in Ontario, many prescription medications are covered under the OHIP+ program.

Who is covered
Anyone 24 years and under who has OHIP coverage and is not covered by a private plan is covered by OHIP+. You do not have to enroll or register to access OHIP+ coverage.

OHIP+ coverage will stop on your 25th birthday or if you become covered by a private plan, but you may qualify for other financial help with prescription drug costs.

If you have coverage through a private plan, but your household still has significant out-of-pocket costs, you can apply for additional financial support through the Trillium Drug Program. The Trillium Drug Program is available to all OHIP-insured Ontarians who have high prescription drug costs compared to their household income.

How the process works
Patients do not need to apply to join OHIP+, nor do they need to pay any upfront costs. Those eligible for OHIP+ only need to give pharmacists their health card number and a valid prescription for an eligible medication. The pharmacist may ask the patient or their parent/guardian if they are covered by a private plan.

What medications are covered
For children and youth without coverage through a private plan, OHIP+ covers the cost of more than 5,000 drug products that are currently available through the Ontario Drug Benefit program, including:

  • antibiotics to treat infections
  • inhalers for asthma
  • various insulins, oral diabetic medications and diabetes test strips
  • epinephrine injectable products (e.g. auto-injectors)
  • drugs to treat arthritis, epilepsy and other chronic conditions
  • medications to treat mental health conditions (e.g. antidepressants)
  • attention deficit hyperactivity disorder (ADHD) drugs
  • drugs to treat some childhood cancers and other rare conditions
  • help to quit smoking: up to a year of pharmacist-assisted counselling (talk to your pharmacist or health care provider)
  • drugs for treatment if you are age 18 years or older

If you are unsure about a medication’s eligibility for this program, you can search for covered drugs

Medications available through the Exceptional Access Program may also be covered if an individual qualifies.

Exceptional Access Program
The Exceptional Access Program (EAP) provides patients access to drugs not listed on the ODB Formulary, or where no listed alternative is available.

Children and youth with no private plan and an approved EAP request are fully covered for the cost of their medications under OHIP+.

If you have immediate questions or concerns regarding the EAP please contact [email protected].

Trillium Drug Program
The Trillium Drug Program (TDP) is for people who spend approximately 3 to 4 per cent or more of their after-tax household income on prescription-drug costs. The incomes of TDP household members under age 25 would still be factored into the household deductible calculation. However, any medications funded through OHIP+ (for children and youth that do not have coverage through a private plan) do not contribute towards the household’s TDP deductible, as they are not considered out-of-pocket expenses.

Private insurance
Children and youth who are covered by a private plan are not eligible for OHIP+.

Ontario Works, Ontario Disability Support Program, Long-Term Care, Home Care, Homes for Special Care, Community Homes for Opportunity
Children and youth 24 years and under who are eligible for the Ontario Drug Benefit program because they are enrolled in Ontario Works, the Ontario Disability Support Program, receive Home Care, or are residents of a Long-Term Care Home, Homes for Special Care, or Community Homes for Opportunity, will maintain their benefits through the ODB program with no co-pay and no deductible regardless of whether they have a private plan.

Opting out of OHIP+
All Ontario children and youth between the ages of 0-24 who are not covered by a private plan are automatically covered under OHIP+. An individual who does not wish to receive coverage under the program can opt out by contacting: ServiceOntario, INFOline at 1-866-532-3161.

–with files from www.health.gov.on.ca

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