How and why a new universal pharmacare program (OHIP+) was introduced in Ontario for people under 25
Year: 2026
Type: article
Abstract: In Canada, there is an absence of universal drug coverage, referred to as ‘universal pharmacare’. As a result, addressing the patchwork of prescription drug coverage and access challenges many face is a policy priority. Ontario introduced the OHIP+ program in 2018 to provide first-dollar prescription drug coverage for children and youth. We sought to explore key factors that affected how and why the government prioritized expanding pharmacare coverage and why the specific features of the OHIP+ program were chosen over other available alternatives. We conducted a qualitative descriptive study, including document analysis and semi-structured interviews with decision-makers and others involved in or affected by the decision. We analyzed the documents and interviews using thematic analysis guided by analytical frameworks describing universal pharmacare design (the UHC cube) and political factors that affect government agenda-setting and policy choices (Kingdon’s multiple streams framework and the 3I + E framework). OHIP + was elevated to the point of active decision in Ontario through a compelling problem of worsening inequities in access to medicines and growing concerns about unsustainable prescription-drug prices for the system, combined with conducive politics (a looming provincial election) and a range of available universal pharmacare options that opened a window of opportunity for a policy champion, the then Minister of Health, to generate commitment for a new prescription drug program. Once up for active decision, the design of OHIP + was shaped by existing structures already in place for a public drug program (the provincial formulary); a clear mandate and interest from the majority governing party; alignment of organized interest groups in support of OHIP+; and their opposition to a more restrictive essential-medicines-list alternative; overlap with private plans that minimized disruption; supportive public values and evidence, tempered by budget constraints; and an election that served as the proximate trigger to action. The analysis from documents and key informant interviews suggested that OHIP+ pharmacare policy reform was about compromise — a decision to prioritize the breadth and depth of coverage (full, first-dollar, comprehensive-formulary coverage) for a narrowly defined population rather than partial coverage for the entire population, incorporating both political and public opinion and pragmatic, achievable win. The lessons from our study can inform future national pharmacare policy reforms that need to align political factors that shape government agenda setting, policy choices and their implementation through federal leadership partnering with provinces, which has been historically hard to achieve in Canada. Not applicable.
Source: BMC Health Services Research
Institutions: McMaster University, University of Calgary, University of Manitoba
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,290
OpenAlex ID: W7225769740
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