Ottawa dad raising red flag about OHIP +

ohip

An Ottawa dad is raising the red flag after he had to pay out of pocket for a medication that used to be covered by private insurance. 

OHIP + was adversited as a province-wide perk for parents and a capstone of the Wynne government, but just a few weeks in and already parents are already experiencing complications at the counter. 

Derek Heebink went to the drug store on Friday to re-fill a prescription for his four-year-old son to find out his prescribed asthma would cost $130 up front instead of the $11 he paid last year under private insurance. 

"It would have been paid straight up front," he said about the system prior to January 1st, 2018. "I would have gone in and gone out without a problem."

The $465 million a year Ontario Drug Benefit program came into effect on January 1st, 2018. It pays for more than 4,400 drugs for people 24 and under but some are deemed "limited use." Additional medications eligible for funding through the Exceptional Access Program are now also covered for those under 25.

Heebink was told by the pharmacy that the prescription had to be sent to the government for approval. He was given two options: pay now and hopefully get reimbursed later or leave the prescription at the pharmacy and wait to hear back from the government.

"This is something we needed to get and we needed it right away," he said. "The pharmacy didn't seem to know how long it would take, which is kind of a concerning thing because it is a government thing. Does it take a day, a month?"

It's a complication pharmacists across the province are experiencing. 

"I've see a lot of prescriptions that are valid and I can filld them, but the doctor has to put in a limited use code and not everyone qualifies for that," said Roxanne Manteza, at the Rideau Pharmacy. "There is a bit of miscommunication there." 

For those who have private insurance for health-care expenses, OHIP+ is now the “first payer” for approved medications. That means, even if both parents of a sick child have drug coverage through their workplace benefits plans, they first have to seek access to the medication through OHIP+. If the government doesn’t cover the cost of the drug, they can then seek reimbursement from their insurance providers.

The government has created a website for residents to check the coverage of their prescribed medication. 

Heebink said he can afford the medication, but worries other people who cannot will be blindsided at the counter. 

"I can handle it, but I know there are people out there with private insurance who wouldn't want to pay $130 dollars for an asthma inhaler or more for other drugs," he said 

The Ontario Ministry of Health has said the government is working closely with the private insurance industry “to ensure that Ontarian children and youth receive the best patient care and experience, and that drug coverage is not interrupted due to the implementation of OHIP+.”

In an email to CTVNews.ca, the ministry also pointed to a “streamlined” form for drug approvals under the Exceptional Access Program, which is meant to reduce the amount of administrative work required to complete them and the time it takes to assess each case.

With files from Sonja Puzic, CTVNews.ca