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Pharmacist questions double-billing of youths under OHIP+

Last Updated Mar 1, 2018 at 6:32 pm EDT

At least one Ontario pharmacist is questioning the province’s new program covering medication costs for those under 25, arguing taxpayers are now paying for drugs previously covered by private insurance.

The province launched its OHIP+ program on Jan. 1, offering four million children and youth free access to more than 4,400 approved medications.

Children and youth need only a valid prescription and health card to access medication with no deductible or co-payment. Moreover, pharmacies have been ordered to bill OHIP+ first before any other existing coverage.

“Why it’s been assessed that private insurance needs a break is beyond me,” said Toronto pharmacist Joseph Fanous. “Nobody had asked for that.”

Since Jan. 1, more than 900,000 youths had more than two million prescriptions filled. The Ministry of Health would not say how much it paid for those medications.

Fanous said it’s troubling that he’s being ordered to bill taxpayers for drugs that are already covered by private insurance. Roughly 2.8 million youths in Ontario already have coverage through other plans that are now being bypassed.

“It’s baffling to be honest,” Fanous said. “They legally insist on being first biller. They don’t give us the option to bill the secondary … So what that really means is tax money is being set aside, quite a lot actually, to pay for these medications. But why are they paying when private insurance is insisting on paying?”

For instance, undergrad students at the University of Toronto already pay $176 per year for coverage that is no longer used.

Aaron Wudrick of the Canadian Taxpayers Federation said it shows Kathleen Wynne’s Liberals didn’t fully think the plan through.

“The fact they are paying now for people who don’t actually need the help is just a waste of taxpayers’ dollars,” Wudrick said.

Health Minister Helena Jaczek would not say why the province insists on being billed first.

“We’re working with the insurance companies and we are now covering 4,400 drugs through our OHIP+ program,” she said.

A spokesperson for the minister later added there are no additional costs or increased taxes and it’s part of a move towards full pharmacare for everyone in the province.