OHIP+ creating barriers for some kids on meds
The drug program LONDON, ONT. Ontario’s Liberal government says will provide unparalleled care for those under age 25 has created barriers to some children getting timely access to medication that keeps them off the surgeon’s table, a leading specialist says.
Dr. Eric Benchimol treats about 300 children at any time at Children’s Hospital of Eastern Ontario in Ottawa and 60 per cent rely on costly drugs he must adjust to keep pace with serious disorders of the gut, such as Crohn’s disease and ulcerative colitis, when medications fail, one recourse is major surgery that removes all or part of the colon and intestines.
Until this year, many of those kids were covered under private insurance through their parents’ employers, and when diseases took a turn for the worse, or when drug levels in the blood fell below where they needed to be, those insurers gave specialists the flexibility to quickly increase the dosage or frequency of medications, such as Remicade and Entyvio.
That flexibility has been shut down by those who administer the new program for those under age 25 called OHIP+. “OHIP+ doesn’t allow for that,” Benchimol said.
Ontario’s Health Ministry is now requiring specialists who need to increase dosage or frequency to apply for exceptional access, a process that creates delay that could hurt patients, he said. Just as concerning, those who administer OHIP+ and decide about drug access are asking for documentation that reveals ignorance about disease as if their state of knowledge was frozen nearly 15 years ago.
“I’m fully supportive of universal pharmacare,” Benchimol said. “(But) The process (to implement OHIP+) may have been rushed because of political will.”
The ministry failed to consult specialists before announcing the new drug program, he said.
That’s left families of patients uncertain if their children will suffer, or whether private insurers will fill the gaps created by the new drug program, he said.
“It’s extremely stressful for (the children’s) families,” he said.
That circle of pediatric patients has been growing rapidly — in the past 15 years in Ontario, there has been a 50 per cent increase in the number of newly-diagnosed cases of Crohn’s and colitis, while in Canada, those diseases are growing fastest among kids five years old and younger, said Benchimol, whose cutting-edge research led to him being named chair of the Canadian Gastro-Intestinal Epidemiology Consortium and the recipient of a New Investigator Award from the Canadian Institutes of Health Research.
While pediatric patients and their families will bear the brunt of problems brought on by OHIP+, cash-strapped Ontario hospitals are also losing out, he said, because pediatric nurses are being forced to document treatment decisions so old that some involve patients who are now in their mid-20s.