“Under the OHIP+, rollback, the government will still provide coverage for those who lack it and stop paying for those who have it,” writes Helen Stevenson.
“Under the OHIP+, rollback, the government will still provide coverage for those who lack it and stop paying for those who have it,” writes Helen Stevenson.
What is the best way to make sure all Ontarians get the medicine they need? This is an oft-asked and much-debated question that directly impacts the quality of life and health of society. Among the current mix of public and private plans, the most impactful approach is for government to fill the gaps in coverage.
As it stands, the provinces manage and pay for their own public drug plans — in Ontario, the publicly funded Ontario Drug Benefit (ODB) plan covers seniors, those in financial need, and people in long-term care homes.
The majority of Ontarians (8.8 million according to Canadian Life and Health Insurance Association) receive drug coverage from private plans through their work, university/college, or union, to name a few. While the current public-private drug plan mix is a patchwork, it’s a patchwork that has worked for almost 60 years.
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The Ontario debate is a microcosm of what is happening across the country. Ninety-five per cent of Canadians are eligible for prescription drug coverage, yet there are calls for the system to be blown up. There is no “one-size-fits-all” plan that is everything to everyone. When it comes to drug plans in this country, I have advocated for the most feasible, practical, and affordable route to filling the gaps.
Filling the gaps in coverage is the right approach. The government — whether provincial or federal or a combination — should serve as second payer for those who don’t qualify for their provincial or employer plan. This would ensure all Canadians have access to essential medicines without blowing up the system and prevent a massive shift in resources from the private sector to the public sector.
The previous Ontario government — under then Health Minister, Eric Hoskins — introduced and put in place OHIP+ as of Jan. 1, which expanded eligibility of the ODB plan to include Ontarians under the age of 25. Originally designed to cover seniors and people on social assistance, the ODB program automatically enrolled all people under 25, whether they had coverage or not.
Health Minister Christine Elliott recently announced a rollback of the policy, shifting the province’s role to that of “second payer” instead of only payer or first payer.
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Critics positioned the rollback as a cruel measure in which the government is taking something away from its citizens. However, this is an unhelpful mischaracterization. Over two million OHIP+ beneficiaries were previously covered by employer-sponsored plans. Also, a large number were eligible for coverage in a public plan but were not enrolled.
Critics have also said the OHIP+ rollback will cost Ontario businesses and families millions of dollars through increased premiums. This is likely not true as many insurance companies had not yet reduced premiums due to the introduction of OHIP+. I expect there will be no change due to the rollback.
Another problem is that in some cases OHIP+ offered fewer drugs or drug alternatives, as private plans tend to cover more drugs and offer many alternatives. Since OHIP+ was mandatory, some individuals received reduced coverage.
Under the rollback, the government will still provide coverage for those who lack it and stop paying for those who have it.
THE BIG DEBATE: For more opposing view columns from Toronto Star contributors, click here.
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Our research shows the Ontario government spent $198.6 million on prescription drug claims for residents under 25 in the first four months of 2018. Projected over a 12-month period that number is $600 million.
Why does this matter? The crux of the issue is that any extra money being pumped into the system should be targeted and spent on Ontarians — irrespective of age — who have no coverage and cannot afford it.
The decision to rollback makes sense fiscally and, looking at it broadly, is a model that should be used for other Ontarians who do not have coverage and cannot afford it. The government has a responsibility to fill the gaps in coverage with a common-sense approach. It is important to remember that governments do not pay for prescription drug plans; taxpayers do.
The second payer approach gives coverage to those who need it, when they need it.
Helen Stevenson is a former assistant deputy minister of health who oversaw Ontario’s $4-billion drug program and the founder of Reformulary Group.
