OHIP+ changes force Hamilton student into health dilemma with risky consequences

The provincial government has taken away access to free prescription drugs for people under 25 if they have private insurance  — a move that's left one Hamilton student with a chronic illness forced to make a tough decision with dangerous consequences.

Uwais Patel, a fourth-year McMaster student with Crohn's disease, says his "heart dropped a little" when he learned he'd no longer be covered under the Ontario Drug Benefit program. 

Patel needs an expensive daily mix of drugs to keep him out of hospital. Under the former OHIP+ program, he received mostly everything for free. One prescription drug, which Patel takes to stay in remission and receives for free under the Compassionate Relief Program, costs around $6,000 a month.

"It was very disappointing to see the changes the government made ... the stress and anxieties that [the changes] bring can also exacerbate my condition," he said.

The partial repeal of the pharmacare program came into effect April 1, causing those with private coverage to lose free, unrestricted access to over 4,400 taxpayer-funded prescription drugs.

Patel is one of many McMaster students who have lost access to the program. Their student health plan is considered private coverage. 

In a statement posted online in January announcing the changes, the Ministry of Health noted it was "fixing OHIP+ by focusing benefits on those who need them the most."

Children and young adults without secondary coverage will continue to receive covered drugs for free through the program, which was created by the former Liberal government. 

CBC News requested comment from Health Minister Christine Elliott on this story, but did not hear back before the time of publishing.

The backup plan

The McMaster plan has an annual prescription drug allowance of $2,500 and provides up to 80 per cent reimbursement for drug costs, requiring students to pay out-of-pocket for the remaining 20 per cent.

Most students don't exceed the drug allowance, but it can be "used up pretty quickly" depending on a student's medical needs, said McMaster Student Union Vice President Steph Bertolo.

For Patel, the drug allowance allotted under McMaster's plan is nowhere near enough. 

He'll use remaining savings from a summer job and the earnings from a current part-time job to make up the difference, but it might get to a point where Patel has to choose which medications he can afford to take.

"If I don't take my medication, I'll end up getting worse. And if I get worse, that just means I'll end up being hospitalised again and it poses more severe consequences to my health," he said. 

If it were possible to ditch the student plan for OHIP+ in order to get free prescriptions again, Patel would do it in a heartbeat. But that option isn't on the table.

McMaster students are automatically opted-in to the student health plan upon enrolling full-time, Bertolo explained. In order to opt-out of the plan, the parting individual must first prove they have access to alternate private insurance.

And OHIP+ doesn't qualify as private insurance, given it's a public service.

"Before the change, I did go to my doctors and request a new prescription for a larger amount … so that I'd be ok until my coverage ended in August," Patel said.

Despite that, Patel says he's already used up almost all of his $2,500 allowance, with four months still remaining until his coverage expires.

After that Patel says he'll have to pay entirely out of pocket.

"We all have different needs when it comes to the healthcare system," Patel said.

The government's approach of separating people into two basic categories of those with private coverage and those without can become a slippery slope, he said, as it disregards those with "extenuating circumstances."

"When it comes to their health, they end up suffering," he said.

Not just money

Students were excited at the onset of the pharmacare program under OHIP+.

It provided them autonomy to privately obtain prescriptions for mental health conditions, as well as birth control — all without having to go through their parents' insurance, Bertolo said.

Intrauterine devices, or IUD's, are a highly-effective form of female birth control that were covered under the former program. They are no longer covered and cost around $400 per unit.

The repeals made by the Ford government revoke the autonomy granted to students. The changes will not only be expensive for students — they can also affect students' mental and physical health, Bertolo said.

They can create potentially awkward and tricky family situations for students wanting to start on birth control or antidepressants.

If a student's parents disapprove of their decision, Bertolo explained, that could dissuade the student from pursuing antidepressants or birth control, which could lead to unplanned and undesired outcomes.

The changes to OHIP+ also reinstate more bureaucratic roadblocks that get in the way of students accessing basic health services, said McMaster Student Health Education Centre Coordinator Adrianna Michell.

Whereas it used to be as simple as getting your prescription filled without touching your wallet, the process has reverted back to a more complicated structure of paper-trails and waiting, she said.

Students must now pay out of pocket, then submit their prescription through private insurance and wait for reimbursement, all-the-while knowing they won't get the entire sum back.

It felt unfair to be granted a system that provided such ease, only to have it taken away suddenly, Patel said.

'We're the last to find out'

Bertolo works full-time for the MSU and stressed the importance of the organization's responsibility to represent and support McMaster students.

It's a difficult task to accomplish when students come to her office for help, and she has no answers for them — Bertolo and the MSU are usually looking for answers from the government themselves, she said.

"We're the last to find out," Bertolo explained about the lack of notice regarding OHIP+ changes from the government.

Bertolo, along with other members of the Ontario University Students Association (OUSA), met with the Minister of Training, Colleges and Universities last November to discuss programs in place for students.

They discussed OSAP funding and OHIP+ coverage with Minister Merrilee Fullerton, among other topics regarding student well-being.

"Looking back on the meeting, we had no idea that these changes were coming," Bertolo said.

She hopes future announcements made by the government regarding programs that largely affect students will be better communicated through targeted ads and direct consultation with student groups.

For the time being, students sit on edge waiting for the next announcement, she said.