See the original letter here.

Starting January 1, 2018 all Ontario residents age 24 and under who have OHIP coverage are automatically covered by OHIP+: Children and Youth Pharmacare.

OHIP+ covers all drugs currently eligible through the Ontario Drug Benefit (ODB) program. Additional drugs not covered by the ODB formulary may also be eligible for funding through the government Exceptional Access Program (EAP) under specific clinical circumstances.

The government Exceptional Access Program (EAP) enables access to drugs not funded on the Ontario Drug Benefit (ODB) formulary, or where no appropriate alternative is available on the ODB formulary. Doctors are required to submit a request to the government for consideration of coverage through the EAP on behalf of their patient. With an approved EAP request there will be full coverage for the cost of that medication.

Because drug funding decisions under the government EAP can take time, Empire Life, like other Canadian insurers, agreed to temporarily assist with coverage from January 1 to June 30, 2018, for the following specific categories of EAP drugs:

• Antibiotics and anti-infectives
• Blood thinners
• Drugs with low EAP approval rates

Beginning on July 1, 2018, these drugs will no longer be eligible for coverage under the private plan unless a plan member’s application for coverage under the EAP is denied. If an EAP request is denied, the drug could be covered under your private drug plan if it is eligible, and subject to any plan design limitations.

ACTION REQUIRED

If you or your dependents are taking a drug on an ongoing basis that fits the above specific categories of drugs noted above, talk to your doctor to see if the drug you are taking could be eligible for funding under the government’s EAP. If it is — and your doctor recommends you continue to take the current drug — you should ask your doctor to submit an EAP request form now to avoid interruption of coverage on July 1, 2018.