What is OHIP+ and Does It Cover Birth Control?

OHIP+ (Ontario Health Insurance Plan Plus) gives Ontarians 24 and under access to free prescription drugs, including some birth control methods. The program covers over 4,400 products. If you qualify, you pay nothing at the pharmacy.

To qualify for OHIP+, you must:

• Be 24 or younger (read further down if you're over 24)
• Have a valid Ontario Health Card
• Not be covered by a private insurance plan

If you meet all three, your prescriptions are free. Birth control is part of that.

Methods that are clearly covered include:

• Combined Oral Contraceptive Pills: Examples include Alysena 21, Alysena 28, Aviane 21, Aviane 28.
• Emergency Contraceptive Pills: Brands like Plan B and Contingency 1.
• Other Methods: Depo-Provera injection, Kyleena IUD, Mirena IUD, Nexplanon implant.

OHIP+ stops at 24. Once you turn 25, you'll need another way to cover the cost: private insurance, employer benefits, or programs like Ontario Works or ODSP if you qualify. Plan with your doctor before the cut-off to avoid a coverage gap.

Without OHIP+, birth control adds up. Typical costs:

• Birth Control Pills: These can cost between $20 and $50 per month.
• IUDs: An intrauterine device can cost up to $400.
• Emergency Contraceptives: These can cost around $40 per dose.

How to Check if Your Birth Control is Covered

The Ontario Drug Benefit Formulary is the official source. Here's how to use it:

1. Visit the Website: Go to the Ontario Drug Benefit Formulary website.
2. Search for Your Medication: Use the search bar to enter the name of your birth control method.
3. Review the Results: Check the details to see if your specific brand and type are listed.
4. Note Any Restrictions: Some drugs may have specific conditions or limits on the number of units covered.

Your doctor can help you verify and work around coverage issues:

• Talk to your doctor: They can suggest covered alternatives if your preferred method isn't on the list.
• Get the prescription details right: Formulation and dosage sometimes change whether something's covered.
• Exceptional Access Program (EAP): If you need a specific brand that isn't covered, your doctor can apply through EAP on your behalf.

Not all methods are covered equally. Things to know:

• Brand vs. Generic: Generic versions of medications are often covered when branded ones are not.
• Quantity Limits: Some birth control pills are covered only in specific pack sizes, like 21-pill or 28-pill packs.
• Conditional Coverage: Certain methods might be covered only if you meet specific health criteria. Your healthcare provider can help determine if you qualify.

Pharmacists are an underused resource:

• Stop by the counter and ask whether your method is covered.
• They can suggest covered alternatives if your preferred option isn't.
• They can also help with EAP paperwork if you need a specific brand.

Definitely Covered Birth Control Methods

Combined Oral Contraceptive Pills

Combined oral contraceptive pills (often just called "the pill") contain both estrogen and progestin. Many are covered under OHIP+.

Covered brands include:

• Alysena: Available in both 21-pill and 28-pill packs.
• Aviane: Offers 21-pill and 28-pill options.
• Brevicon: Covered in 21-pill and 28-pill formulations.
• Cyclen: Both pack sizes are covered.
• Loestrin: Available in 21-pill and 28-pill packs.
• Tri-Cyclen: Offers both 21-pill and 28-pill options.

21-pill vs. 28-pill packs:

• 21-pill: 21 active pills followed by a 7-day break (or 7 placebo pills if they're provided separately).
• 28-pill: 21 active pills plus 7 placebos so you take a pill every day. Easier to stay in the habit.

Emergency Contraceptive Pills

Emergency contraceptive pills (ECPs) prevent pregnancy after unprotected sex or contraceptive failure. OHIP+ covers them in specific situations.

Covered brands:

• Plan B: Effective within 72 hours after unprotected sex.
• Contingency 1: Another brand that provides emergency contraception within 72 hours.
• Backup Plan One-Step: Similar to Plan B and used in the same time frame.

ECPs are for occasional use, not as a regular method.

Other Methods

Depo-Provera: An injection given every three months. Contains progestin, prevents ovulation.

Kyleena and Mirena IUDs: Hormonal IUDs that release small doses of progestin locally. Kyleena lasts up to 5 years, Mirena up to 7.

Nexplanon implant: A small rod inserted under the skin of the upper arm. Releases progestin and works for up to 3 years.

Birth Control Methods Not Covered by OHIP+

Newer Oral Contraceptives

Not every pill is covered. Newer brands are often excluded because:

• Higher cost: OHIP+ aims to cover effective and affordable options.
• Generic alternatives exist: When a generic with the same active ingredient is available, the formulary leans toward the generic.

Patches and Rings

Patches and rings are not covered:

• Evra Patch: A weekly skin patch that releases hormones. Convenient, but pricier.
• NuvaRing: A flexible vaginal ring left in for three weeks at a time. Same hormone class as pills, different delivery, higher cost.

Non-Hormonal IUDs

Non-hormonal IUDs aren't covered:

• Copper IUD: Lasts up to 10 years, hormone-free. Good for people who want to avoid hormones, but the upfront cost is high.
• Jaydess IUD: Hormonal, but not covered because it costs more than Kyleena or Mirena. Lasts up to 3 years and is smaller, which some users prefer.

Knowing what's not covered helps you weigh alternatives with your doctor before committing.

Conditional Coverage: The Gray Area

How Conditional Coverage Works

Some methods fall between definitely-covered and definitely-not. Conditional coverage means OHIP+ may pay under specific circumstances:

• Generic preferred: If a generic version exists, OHIP+ leans toward covering it instead of the brand.
• Cost-effectiveness: Methods that match the benefits of another option at lower cost get the priority.

When Health Reasons Can Get You an Exception

Coverage exceptions are possible when your doctor can document medical necessity. Common reasons:

• Allergies: If you react to ingredients in the generic, you may need the brand.
• Severe side effects: If a generic causes problems, your doctor may switch you to a different brand that's normally not covered.
• Specific conditions: Hormonal imbalances or menstrual disorders sometimes call for a specific formulation.

Applying Through the Exceptional Access Program (EAP)

If you need a method that isn't normally covered, EAP is the path. Steps:

1. Talk to your doctor about why a specific method is needed and why alternatives don't work for you.
2. Your doctor fills out the EAP forms and documents the medical reasons.
3. Submit the forms (often online, or through the doctor's office).
4. EAP reviews and decides based on medical need.

Pills with Conditional Coverage

Some brand-name pills are conditionally covered, usually if generics don't work for you:

• Alesse: Often covered if generics cause side effects.
• Apri: Similar to Alesse, covered if generics aren't suitable.
• Marvelon: Sometimes covered for specific health reasons.
• Yaz: Conditional coverage if other options don't work or cause severe side effects.

Coverage After 25

Once you turn 25, OHIP+ ends. You'll need another way to cover your prescriptions.

Why 25 is the Cutoff

OHIP+ is specifically for people 24 and under without private insurance. The day after your 25th birthday, you're on a new plan: whatever you've lined up, or paying out of pocket.

What to Look At

The transition feels rough but there are options:

• Private/employer plans: Many employers cover prescriptions. Check what's included if you're working.
• Student plans: If you're in school, your university health plan may cover prescriptions.
• Family plans: Some private plans let you stay on a parent's plan until 26.

Ontario Works and ODSP

If you don't have private coverage, government programs may help:

• Ontario Works: Financial and employment assistance for people in financial need. Can include healthcare and birth control costs.
• ODSP: Financial support and health benefits for people with disabilities. Covers prescriptions if you qualify.

Planning Ahead

To avoid a coverage gap when you turn 25:

1. Book an appointment to talk about the transition off OHIP+.
2. Consider longer-term methods that need less frequent renewal (IUDs, implants).
3. Walk through private insurance or assistance options with your doctor.
4. Make sure prescriptions and records are up to date.
5. Apply for new coverage before your birthday, not after.

Online Prescription

TeleTest offers same-day birth control prescriptions and renewals online, with prices and dosages listed upfront, regardless of your OHIP+ status.

Disclaimer: This blog post is intended for educational purposes only and should not be taken as medical advice. Always consult your healthcare provider for personal health concerns.