January 11, 2019: A weekly scan of new legislation and regulations important to the Ontario health sector, as well as articles of interest.
No new bills of interest.
Reg 201/96 – Ontario Drug Benefit Act
Beginning March 2019, children and youth who do not have existing prescription drug benefits covered by privates plans will continue to receive coverage through OHIP+, but for those who are covered by private insurance, those plans will be billed instead. Proposed amendments to O.REG 201/96 to incorporate the following changes to OHIP+:
- Children and youth with private insurance would have access to prescribed medicines as they did prior to the launch of OHIP+ through private insurer as first payor.
- Additional financial support for out of pocket expenses can be applied for through the Trillium Drug Program (“TDP”), and if such out of pocket costs do not reach the TDP deductibles, no public coverage would be provided unless the child/youth becomes eligible through another eligibility stream.
- If such out of pocket costs meet the TDP deductibles, public coverage will be provided subject to a maximum $2 co-payment per prescription that may be charged by a pharmacy.
- Children and youth who are eligible for the Ontario Drug Benefit Program through social assistance, home care services or residence in a home for special care or community home for opportunity would have no co-payments or deductibles.
- Private insurance is defined as any type of private plan, program or account which could contribute to the cost of any drug product, regardless of whether:
- the private insurance plan covers the particular drug for which coverage is sought,
- the child or youth or another person captured under the private insurance plan is required to pay a co-payment, deductible, or premium, or,
- the child or youth has reached their annual maximum under the private insurance plan and no further coverage is available.
Comments Due date: Jan 31, 2019
Articles of Interest
Professional Misconduct and Compliance
What’s happening in our city this weekend: