WALLACE: Liberals OHIP+ prescription drug election plan needs 911

James Wallace     Published: January 14, 2018   Updated: January 14, 2018 8:27 AM EST

The Ontario Liberals “free” OHIP+ prescription drug plan for children and youth, it turns out, is yet another political con from a government notorious for disastrous, costly and outrageously self-serving public policy.

Con as in to scam, hustle, bamboozle, misdirect, dupe and otherwise hoodwink the public into thinking they’re getting a new, valuable and efficient public service that addresses broad societal inequity and “fairness,” which is Premier Kathleen Wynne’s favourite new word.

But like all too-good-to-be-true offers, their OHIP+ drug plan comes with a multitude of holes, flaws and catches and the inequity the plan purports to address – in particular that 1.2 million Ontario children and youth under 24 lack drug coverage – has been callously ignored by the Liberals for the past 14 years until they found themselves, unpopular and scandal-ridden, on the eve of an election.

“OHIP+ represents the biggest expansion of Medicare in Ontario in more than a generation,” Wynne said after her government unveiled the program in its spring budget.

As a campaign policy, OHIP+ has the veneer of a winner. Closer inspection however suggests a cynically crafted, pop-up drug benefits program likely to:

– Cost at least $1 billion annually (more than double projected costs);

– Hand millions of dollars in taxpayers money to insurance companies and businesses;

– Run into trouble in June when the election is over and insurance companies stop propping it up;

– Create a growing, bureaucratic burden for users that is already causing controversy over how families apply for benefits, and what drugs get covered.

Conservative health critic Jeff Yurek, a pharmacist from St. Thomas, said there’s little question OHIP+ was designed to buy “popularity and votes.”

“Kathleen Wynne is only doing what’s in the best interests of Kathleen Wynne and the Liberal Party of Ontario,” he said.

What it fails to do, Yurek suggests, is address coverage problems faced by many Ontarians who need help.

That is the most galling aspect of the Liberal plan, their claim OHIP+ is the “right thing to do” and is intended to help vulnerable populations – especially the 1.2 million children and youth under 25 without drug benefits.

Last time we checked, the Liberals were first elected in 2003 and have had almost a decade-and-a-half to come up with a drug plan to help vulnerable youth.

They didn’t.

Worse, under their watch only 29% of the most vulnerable youth, those on social assistance and other government income supports, are actually enrolled in existing public plans that provide government-funded drug benefits.

Here are the facts, as provided by the Conference Board of Canada.

There are 4,036,200 children and youth in Ontario under 25 according to the Conference Board report the government relies upon.

Slightly more than half (52% or 2.1 million) young people are/were covered by private drug plans before OHIP+ kicked in Jan. 1.

Then there are 1.2 million youth not covered by plans.

Another 751,000 are eligible for coverage through public plans but, under the Liberals, just 218,000 were enrolled prior to OHIP+ through the Ontario Disability Support Program, Ontario Works, Home Care and Trillium Drug Program.

Following the unveiling of OHIP+, Wynne said: “Young people who are trying to get a strong start in life need our support — access to free prescription medication will make life more affordable for them when they need it most.”

Where have she and the Liberals been?

The government knew or ought to have known at-risk youth were not fully participating in the program but never bothered addressing the matter.

They might have helped kids living in high-needs social housing projects or otherwise marginalized by ensuring they were actually enrolled in government drug benefits programs. They might have offered meaningful tax breaks, incentives or funding to working poor families who had no plan.

Instead, the Liberals decided to cover drug costs for 2.1 million young Ontarians already insured through plans commonly negotiated between employers and unions or provided to post-secondary students.

In other words, those who didn’t necessarily need OHIP+.

And in place of private drug plans with defined benefits that typically cover 12,000 to 14,000 drugs, the Liberals are offering an inferior plan covering 4,400 drugs.

The government will decide on a case-by-case basis whether it will cover the other 10,000-odd drugs through its existing Exceptional Access Program (EAP).

To avoid short-term chaos, the Liberals struck a deal with the insurance industry to prop up OHIP+ until June, coincidentally election time.

Until then, young patients will use their OHIP cards to pay for 4,400 commonly used drugs such as antibiotics and asthma puffers and the insurance industry will cover bills from the additional 10,000 their benefits plans currently cover.

However, instead of writing a prescription and handing it to their patients, doctors now and in future will need to fill out a form to apply for coverage for less-commonly used drugs.

“Starting on July 1, 2018, individuals will be required to have their prescriber submit a request for all EAP drugs, including transition drugs,” the Health Ministry explained in response to a question from the Sun.

Meanwhile, the cost of OHIP+ appears grossly underestimated.

The Health Ministry estimates January to June costs will be $115 million, and notes some 220,000 youth – a mix of those with and without plans – have already used OHIP+.

Annually, the government insists the cost of OHIP+ will be a lean $465 million.

However, earlier this month TVO’s Steve Paikin uncovered more realistic numbers during an interview with Helen Stevenson, a former assistant deputy ministry of health under the Liberals who oversaw Ontario’s $4 billion drug program.

Stevenson is the founder, president and CEO of the Reformulary Group, an independent company dedicated to formulary management.

Her company surveyed drug claims from 1.3 million Ontarians covered by private plans and found 344,788 were under 25, then calculated their annual drug costs.

It worked out to:

– $72.5 million for drugs expected to be covered by OHIP+;

– Another $20 million for drugs expected to be covered under the exceptional drug plan.

Extrapolating those figures for a population of 4 million under-25s, the Liberals should expect to pay $848 million for commonly used drugs and another $234 million for exceptional drug coverage.

That’s $1.08 billion annually, not the $465 million the Liberals insist OHIP+ will cost.

A big chunk of that cash is money insurance companies and private companies will no longer have to shell out.

The Liberals say they assume insurance companies and employers will lower plan costs for workers but that won’t happen at least until 2019, if it does at all.

Private plans won’t disappear, which the government acknowledges, nor will all drugs currently covered by private plans necessarily be covered.

“If a drug is not currently funded through the ODB program, it will not be funded through OHIP+ and in this case a private insurer may continue to provide coverage, if applicable,” the ministry said.

That doesn’t mean OHIP+ won’t provide real help to families, particularly the 1.2 million without drug benefits.

The real question is whether OHIP+ is the best and most efficient way to do that.

Stories are already surfacing about families facing approval delays or having coverage stripped by OHIP+.

The Brantford Expositor reported mom Nicole Forbes was told the $800-a-month medication for obsessive compulsive disorder her sons were taking would no longer be covered by her insurance company, and had to fight to get the government’s EAP program to temporarily cover the cost.

Dr. Eric Benchimol at Children’s Hospital in Eastern Ontario told the London Free Press OHIP+ isn’t allowing doctors to increase dosages or frequency of costly drugs for Crohns and colitis without approval, something private plans permit, which is putting stress on the children, their health, their families and the nurses and medical professionals who care for them.

The Liberals, see few problems, perhaps beyond a singular need to get re-elected, and are gushing about OHIP+ publicly in taxpayer-funded TV ads.

“It’s exciting to see the significant impact that OHIP+ is making in the lives of hundreds of thousands of young people across Ontario,” Health Minister Eric Hoskins said in a release this week.

“By providing access to more than 4,400 prescription medications at no cost to all children and youth age 24 and under, we are removing the financial barriers that can prevent them from getting the essential care they need to stay healthy. It’s an important first step towards our vision of a universal pharmacare system for everyone in Ontario.”

And that vision is the problem.

OHIP+ is based on an ideological policy goal to create a universal, public Pharmacare program but is built on a flawed and underfunded patchwork of existing public programs.

Should Ontario voters decide universal Pharmacare is a desirable goal, the question should be how to get there efficiently and responsibly.

Andrea Horwath and the Ontario NDP propose to spend $475 million on a “Pharmacare for Everyone” program that would cover fewer drugs but be available for all the 2 million or so Ontarians who have no drug coverage today.

That makes a good deal of sense.

Patrick Brown and the Conservatives raised concerns about OHIP+ but have promised to keep, and fix it, if elected.

Yurek suggests they’ll “make it more efficient, reduce the administration and bureaucracy and red tape.”

“Whoever gets elected is going to have to address OHIP+,” he said.

That much is crystal clear.

Along with soaring Hydro prices and a broken electricity system, an increasingly dysfunctional and bureaucratic health care system that still hasn’t managed to get ehealth right, OHIP+ is poised to become yet another disaster left in the Liberal wake.