All Ontario children and adults younger than 25 will have their full prescription drug costs covered by a new provincial pharmacare program, regardless of family income or whether they already have private insurance.
The province announced the expanded drug coverage in Thursday's annual budget, a move it projects will cost $465 million per year.
Currently, the Ontario Drug Plan (ODP) covers prescription drug costs for approximately 900,000 families on social assistance and another three million seniors.
If approved, the new program would roll out Jan. 1, 2018 — and would cover 4,400 drugs for the province's four million children and young adults. The medications are the same already included in the ODP, which includes treatment for acute and chronic illness, as well as certain pediatric cancers.
Provincial health department staff could not provide information about all the cancer treatments available under the plan. But, given that many private insurers have limited coverage for at-home oncology care, the move could theoretically save parents thousands of dollars per month, as taxpayers cover the cost.
In-hospital cancer treatment and medication is already covered by OHIP.
How it affects insurance premiums
What this means for the insurance industry — and whether it will reduce family premiums — is unclear.
Health department staff said that while they've had discussions with those in the industry, they couldn't say whether there had been a commitment to change premiums but hope the savings will be passed on to families.
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Under the plan, neither children nor young adults would have to go through their or their parent's private insurer for coverage first. And because the provincial program would be free, patients wouldn't be on the hook for co-payment or dispensary fees, unlike with private coverage.
When asked why the "OHIP+: Children and Youth Pharmacare" plan would apply to those who already have coverage, Finance Minister Charles Sousa said the province wanted people to have equal access to medication.
"Even with those who have plans, they still have co-pays and deductibles and that's a significant expense on them," he said. "You want an income test and we're not doing that."
He also noted that the changing nature of work has seen people working contract jobs, something that has created a drop in the number of people who earn employee health benefits.
Although the Liberals have offered many hints — and advance announcements — about what would be in this budget, the expanded pharmacare program was kept secret.
But the Liberal plan follows a vision recently put forward by the NDP. That plan, however, would have been for fully universal coverage, regardless of age.
But while the New Democrat proposal would have made all Ontarians eligible, it limited drug coverage to 125 medications considered essential, 4,275 fewer than the Liberal plan.
It also requires a co-payment based on a person's income.
What it means for patients
Dr. Danielle Martin, a family doctor and the vice-president of medical affairs and health system solutions at Women's College, described the expansion of pharmacare as a "huge improvement" to the current system.
In her practice, she said she's experienced "many heartbreaking moments" when families are uncertain they can pay for puffers or insulin for their children – or when young women aren't sure how to pay for birth control pills.
'All that remains is to close the gap from 25-65 and I hope that's up for discussion as we move toward the provincial election.' - Dr. Danielle Martin, family doctor and health policy advocate
"I think this puts us far ahead of anyone in the country," said Martin, who has made appearances on CBC's The National. "All that remains is to close the gap from 25-65 and I hope that's up for discussion as we move toward the provincial election."
Although she commended the plan, she said that universal pharmacare is critical to the long-term health of the province's patients and its health-care system.
For those unable to afford medication to manage chronic conditions like high blood pressure or diabetes, the consequences — stroke, vision loss, heart attacks — can be deadly for patients and require costly hospital care.
Peter MacLeod, the chairman of the Citizens' Reference Panel on Pharmacare in Canada, said he sees this as the first step toward complete public coverage.
The report the panel produced for the Canadian Institute for Health Research called for a scenario similar to the NDP proposal, but MacLeod said he's happy to see any plan that increases publicly funded medication.
"This has been called the unfinished business of Canadian health care," he said.
What the other parties say
The NDP has said its proposal would cost roughly $475 million a year, or just less than one per cent of the proposed $53.8 billion in total health-care spending proposed in the Liberals 2017-18 budget.
Sousa avoided directly answering a question about whether the expanded pharmacare program would eventually cover adults, too.
Instead, he said that Health Minister Eric Hoskins has been calling on his federal counterpart to create national pharmacare coverage.
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The Ontario Tories slammed the Liberal plan, saying that it made little sense for the public purse to cover medication for affluent families or those who have private drug coverage.
"It makes no sense that precious funds would go to pay for millionaire kids," Progressive Conservative Leader Patrick Brown said.
The PCs have not released a pharmacare plan themselves, but Brown said they would.
It would not be universal, he said, and would only target those "who actually need it."