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OHIP+: Children and Youth Pharmacare

Mon, 11/27/2017 - 10:48

The Ontario government is partnering with the Canadian Life and Health Insurance Association and member insurance companies, (Empire Life is a member), to ensure eligible Ontario residents who have insurance coverage experience a smooth transition from private plans to OHIP+. We’re here to help guide plan administrators and their employees through the process and help with the transition.

Starting January 1, 2018 all Ontario residents age 24 and under who have OHIP coverage will be automatically covered by OHIP+: Children and Youth Pharmacare. OHIP+ will cover 100% of the cost of over 4,400 drugs through the Ontario Drug Benefit (ODB) program.

All that will be required at the pharmacy is a valid prescription from their doctor and their valid health card or health card number. There will be no out of pocket costs, such as deductibles or co-payments. This program will stop for Ontario residents on their 25th birthday.

Additional drugs, not covered by the ODB formulary, may also be eligible for funding through the government Exceptional Access Program (EAP) under specific clinical circumstances.

Empire Life group plans cover many more drugs than those listed on the ODB formulary. We will continue to cover eligible drugs not covered by the ODB formulary and not funded or not approved through the government EAP, subject to any plan design limitations.

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