Thursday 7 December 2017

Heads Up On Why January 1st Could Get Expensive For Families

Like most of us, I was pleased when the Ontario government announced that it will start covering prescription medication costs for children under 25 as of January 1 2018.  It would have been even cooler if autism treatment had been included, but this is still a great step.

Then I got a notice from my insurance company that they would no longer be covering Alex's medication after December 31st.

Okay, that seemed fair, although writing a letter to tell me that seemed a little cheap and mean.

Then I read the second paragraph, which explained that his medication would not be covered under the OHIP+ program either and that I should contact his doctor.


Not cool, but at least I was given some warning about it.  I contacted our doctor and was told that "Oh yeah, it's definitely covered... well, maybe it will be... you should check with the pharmacist."

So I checked with the pharmacist and found out that the type of medication is covered but the format (liquid instead of pills) is not.  Good news, there's a form that we can complete for an exception (the EAP - Exceptional Access Program).  Bad news: these forms regularly take 8-10 weeks to process and with the surge of applications expected for OHIP+, it could be more like 4-6 months.

Which means there is going to be a gap between lapsed insurance coverage and OHIP+ coverage, a gap that could get very expensive since the medication is about $200 for a 3 week supply.  The next refill would be about two weeks into January, so I'm going to see if I can get it done early, but we've had issues before where insurance refused to cover the costs because we're refilling earlier than they expected.

I'm more than a little annoyed that I was given less than a month's warning to deal with this situation.  Even more annoyed that this seems like bureaucratic bullsh*t, since he a) has a prescription for that medication in that form and b) has been on the medication for awhile, so it's not like we're trying to game the system.

My advice to parents (both special needs and otherwise) is that if your child is on a prescription medication, check with your pharmacist to see if its covered under OHIP+ so that you don't get an unpleasant and expensive surprise in 2018.

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