Starting April 1st, 2019, the government will be changing the focus of the OHIP+ benefits to prioritize youth without a private plan. As a result, Ontarians under 25 years of age who are insured under a private drug benefit plan will no longer be automatically eligible for coverage for their medication under OHIP+.
Trillium Drug Program (TDP):
The individuals or families who have significant out-of-pocket costs, despite having a private plan, could apply for additional financial support through the Trillium Drug Program (TDP). The TDP is available to all PUIP-insured Ontarians who have high prescription drug costs compared to their household income.
Exceptional Access Program (EAP):
Children and youth under 25 years of age who are OHIP insured and who do not have a private plan will maintain their OHIP+ eligibility and therefore, continue to have access to their EAP medication until the expiry date on their EAP approval letter.
Children and youth under 25 years of age who have a private plan and have accessed drug funding through the Exceptional Access Program as part of OHIP+ may now be required to submit a prior authorization form to their private plan in order for coverage to be granted.
Group Premier Medical recognizes the changes that this new law brings. We will remain on the lookout for any modification that could affect our participants and partners. Should you have any questions or concerns please contact your coordinator.