Ask the Pharmacist

Q: What can you tell me about the proposal to cover the costs of drugs for kids in Ontario?

A: As part of the 2017 Ontario budget, the Liberal government put aside a chunk of money to begin paying for the medications for those Ontario citizens who are 24 years of age or younger.

The mechanics of the proposal are as follows: It is slated to start Jan. 1^, 2018, and is to include all youth in that age range regardless of financial status or existing drug coverage from their parents’ insurance plans or those where they attend post-secondary school.

Enrolment is automatic. There are no forms to fill out or any other action required prior to filling that first prescription for the intended youth. Simply present the child’s health card to the pharmacy of your choice and the bill will be sent on-line to the government. There are no co-pays or any other form of deductible required as there are with so many private plans, as well as those run by the government for seniors or those with low income.

While not all drugs are automatically paid for, the majority certainly are with the list being identical to the coverage provided for seniors and other groups whose medications the government helps cover. The most common medications that kids in these age groups require, such as antibiotics, acne creams, oral contraceptives, drugs to help with ADD and inhalers, are very well represented on this list.

For those drugs that the government does not usually pay for, there is still a way to possibly get it to reconsider on an individual basis. This is called the Extended Access Program (EAP) and it involves the prescribing physician contacting the government and making a case as to why it should pay for this particular drug for this unique individual. As such, there is at least a chance that any available prescription drug could be covered for youth under this new program.

For youth whose drugs are already paid for by the government, such as those with disabilities or on home care, coverage will continue uninterrupted with the only difference being that those $2 co-pays for each prescription will disappear.

For those families who have coverage under the Trillium drug plan, the kids will still be listed as dependents and any income they receive still is added to the overall household income. The only real difference will be that now their drug costs will no longer count towards a family’s annual deductible since there will obviously be no drug costs with the inception of this plan.

For those who do not wish to be automatically included in this plan, they can contact Service Ontario (1-866-532-3161) to opt out, although, once again, there is no financial reason to take this action.

Feedback from most groups has been generally positive with the main negative being that some do not believe that it goes far enough. There are many in Canada who question why we have universal coverage for physician’s fees (at least the vast majority of them) and hospital visits and yet the cost of drugs, which are progressively getting more expensive by the year, are borne by the individual in some way shape or form.

The question as to why this dichotomy exists is undoubtedly answered by looking at the costs of such a program on a universal scale. Yet, many experts argue that if Canada were to cover medications for all Canadians, rather than the ad hoc process we have now where each province or employer bears the costs itself, the government would be able to use that buying power to leverage the pharmaceutical companies way down in price; thereby, saving significant money overall.

Still even those who feel that way, argue that this is at least a good first step towards that eventual goal and a relatively easy one at that. That's because youth do not use nearly as many prescription drugs as the rest of us who are dealing far more commonly with high blood pressure, diabetes and the like.

As well, the government already pays for drug coverage for approximately 600,000 individuals in this age range through its various other drug coverage programs. As such, the government estimates that incorporating this coverage into its budget should add only about $465-million per year in order to cover all four-million people under the age of 25.

It will be interesting to see what the ramifications of this will be on other governments within Canada, as well as on the budgets of assorted employers and insurance companies who will no longer be on the hook for these costs.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts