OHIP+ is a Great Step Towards A Universal Prescription Drug Coverage Plan
The Ontario government has proposed a plan in their 2017 Ontario Budget to introduce a universal prescription drug coverage plan called OHIP+. In the present OHIP program, the major parts of it covers all Ontario residents above the age of 65 years and the Trillium Drug Program covers people that spends more than 3 to 4% of their household income on prescription drug cost. However, the patients that are covered still pay a deductible. The introduction of OHIP+ will cover all 4400 drug products that are currently available through the Ontario Drug Benefit program for Ontario citizens under 25 years of age as long as they have OHIP coverage. Despite OHIP+ having a great deal of advantages, it is receiving substantial criticism with a major one being the immediate cost of implementing such a program. Nonetheless, OHIP+ will alleviate the prescription cost placed on many Ontario residents either due to the lack of private insurance or not falling under the specific OHIP criteria, helping reduce the drug cost in general by making a single purchasing and negotiating agency and also reduce future healthcare cost by allowing youth to have access to preventative healthcare measures.
The cost of prescription medication in Ontario can be prohibitively expensive for people and their families who are not covered by Ontario’s selective drug benefit programs or fortunate enough to receive drug coverage through their employer’s insurance program. Youth and adults today are negatively affected by some of the highest prescription drug costs in Canada compared to other countries, for example 1 in 10 Canadians cannot afford medicine prescribed to them with 27% of Canadians aged 18 to 24 and 24% of Ontarians facing healthcare access barriers (1). The Trillium Drug Program assists households who meet an annual threshold for spending money on prescription drugs, while the Ontario Drug Benefit Eligibility program only provides assistance for seniors ages 65 and up. Consequently, adults not falling under any of the aforementioned categories are left with prohibitive out-of-pocket drug costs. Furthermore, young adults are less likely to have drug coverage through private insurance, compared to middle-aged citizens of Ontario. Private insurance is often a facet of full-time work whereas people beginning their careers may be involved in more part-time, internship, or contract work. In a recent study, researchers demonstrated that only about 58% of Ontarians below the age of 65 reported holding employer-sponsored drug coverage (2), while another study demonstrated that that lack of holding private drug coverage in Ontario correlates with lower accessibility to physician care as well as higher patient reports of unmet healthcare needs (3). These study results suggest that Ontario’s selective drug benefit programs are inadequate in benefiting all citizens. When 1 in 5 Canadian citizens are paying $500 or more on for their household prescription and 7% are paying over $1000 (1), the current system is evidently not helping much. When a program such as OHIP+ seeks to improve prescription medication access for Ontario’s youth, it assesses financial challenges in concrete ways for one of the most financially vulnerable age groups of the population.
To further exacerbate the aforementioned out-of-pocket drug expense, the lack of universal drug coverage and multiple purchasing and negotiating agencies gives drug manufacturers the ability to raise prices. This model is exemplified when comparing Canada’s system to that of New Zealand; New Zealand provides universal outpatient prescription drug coverage alongside their universal healthcare coverage. One significant difference between New Zealand and Canada is the considerable difference in specific drug costs. Amlodipine, a popular blood pressure treatment made by the Canadian company Apotex, annual cost in Canada is $130 while in New Zealand, the same drug costs around $10 annually (4). A recent study demonstrated that Canada can potentially save 21% to 79% on drug prices on the four largest drug classes alone, by following an universal drug coverage plan (5). Experts believe that due to New Zealand’s single purchasing and negotiating agency, they have more leverage when negotiating better drug prices (4). Thus, the implementation of OHIP+ could potentially translate into millions of dollars in annual savings for both the Government of Ontario and its residents. This challenges the main criticism of OHIP+, which is the burden of the tremendous cost of OHIP+ that would be placed on the taxpayers. However, shown by the arguments above, the cost effectiveness of OHIP+ over time would be significantly greater than the present system.
The cost-effectiveness of OHIP+ not only is achieved through a single-negotiating body to reduce drug prices themselves, but also through preventative healthcare measures. Treating healthcare concerns proactively or with the appropriate types, quantities, and application of prescription medication before the onset of serious illness can be a cost-effective move for governments. For example, an observational study showed that by taking oral diabetes drug metformin reduced the risk of the onset of type 2 diabetes (6). The investment of capital into OHIP+ is far outweighed by the savings that the Government of Ontario would achieve, as preventative and active treatments early in life would significantly reduce the need of patients requiring more prescription medications later in life. In fact, OHIP+ would reduce of the cost of running the Ontario Drug Benefit Eligibility program through the model of preventative and proactive prescription drug administration.
OHIP+ seeks to implement a life-changing universal drug coverage plan for youth under the age of 25 in Ontario, reducing gaps caused by the current mix of private and public drug payment assistance programs. The Government of Ontario targets youth as they are a vulnerable group to falling upon prohibitively high prescription medication costs; this is especially prevalent considering private drug insurance is a luxury of full-time workers and the Ontario Drug Benefit Program only assists the elderly. Enacting a more universal drug coverage plan would allow for greater negotiation of drug prices, following the model of other developed countries such as New Zealand. Ultimately this would save money for both the government and the residents of Ontario by lowering the cost of prescription drugs at its root. Furthermore, covering the cost of medication for youth under 25 years of age would incur long-term savings and health benefits through a preventative healthcare approach. Implementing OHIP+ would take Canada one step closer towards achieving universal outpatient prescription drug coverage by demonstrating to the Prime Minister the possibilities or as Ontario’s Health Minister Eric Hoskins said “I think if there is one message today it's that this is possible”.