Regulation - LGIC

Proposed Amendments to Ontario Regulation 201/96 made under the Ontario Drug Benefit Act

Regulation Number(s):
201/96
Bill or Act:
Ontario Drug Benefit Act
Summary of Decision:
A notice was posted on the ministry's website on February 29, 2016 that provided stakeholders with information on the proposed amendments to the ODBA Regulation. Stakeholders were given a 30-day period to comment on the proposed regulatory amendments.

Based on the feedback provided during the consultation period, the Government revised its proposal for changes to the ODB program for August 1, 2016 that were originally announced in the 2016 Ontario Budget. The Ontario Government will not be increasing the non-low-income seniors' co-payment and deductible, as originally proposed.

On April 14, 2016 the Ontario Government approved amendments to Ontario Regulation 201/96 made under the Ontario Drug Benefit Act ("ODBA Regulation") that will update the income thresholds used to determine eligibility for the Ontario Drug Benefit (ODB) Program's Seniors Co-Payment Program (SCP), expanding access to this program for over 170,000 currently ODB-eligible seniors.

Effective August 1, 2016, the income thresholds for the Seniors Co-payment Program were updated per this direction
Further Information:
Proposal Number:
16-HLTC002
Posting Date:
February 29, 2016
Summary of Proposal:
Patients First: Ontario's Action Plan for Health Care reflects a commitment on the part of the ministry to build a health-care system that is patient-centered. A sustainable drug system, working together with our partners, puts Ontario in the best position to ensure access for patients to drug products that they require.

The Ministry of Health and Long-Term Care (the "ministry") is proposing to update recipient cost-sharing arrangements for non-low income seniors as well as expand eligibility for the Seniors Co-Payment Program under the Ontario Drug Benefit (ODB) program, in order to reflect increases in cost-of-living and seniors' income supplements in Ontario since the co-payment and annual deductible rates were set. Introduced in 1996, these are the first changes in 20 years.

Proposed amendments to Ontario Regulation 201/96 made under the Ontario Drug Benefit Act are required to support these proposed changes, which include:

• An increase to the income threshold for low-income seniors from <$16,018 to ≤$19,300 for single seniors and from <$24,175 to ≤$32,300 for senior couples in order to expand access to the ODB program's Seniors Co-Payment Program (SCP). The SCP reduces low-income seniors' out-of-pocket drug costs to a $0 annual deductible and up to a $2 co-payment per prescription;

•$70 increase to non-low income seniors' annual deductible (from $100 to $170); and

•$1 increase to non-low income seniors' co-payment per prescription (from $6.11 to $7.11).

Housekeeping changes to Ontario Regulation 201/96 are also included in this amendment and pertain to pharmacy claim submissions under the ODB program.

The minor changes include:

• Removing outdated dispensing physician offsets; and

• Revising the two dispensing fee per month (30 days) policy to two dispensing fees per 28 days.
Contact Address:
Executive Officer, Ontario Public Drug Programs
Ministry of Health and Long-Term Care
80 Grosvenor St., 9th Floor
Hepburn Block, Queen's Park
Toronto, ON M7A 1R3
Fax: 416-325-6647
Effective Date:
August 1, 2016
Decision:
Approved