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What is Covered by OHIP+: Birth Control Edition

OHIP+ came into effect on January 1st, 2018. OHIP+ is also known as Child and Youth Pharmacare. It makes many medications free for children and youth up to age 24. (For more info, check out our previous post and infographic on OHIP+: Link.)

It can be confusing to figure out what specific birth control options are covered by OHIP+. Not all brands of the same product may be covered. For the brands that are covered, there may be a restriction on the number of pills for each brand that can be covered. For instance, Brand X with 21 pills may be covered while the same brand with 28 pills might not be covered.

This post is a list of the hormonal birth control options and brands for those that are definitely covered, those that are not covered and those that are accessible under certain circumstances. We hope you find this list useful!

Definitely Covered 

These are birth control methods that are definitely covered under OHIP+.

Most combined oral contraceptive pills (aka birth control pills or The Pill):

Brevicon 28, Brevicon 1/35 21, Brevicon 1/35 28, Cyclen 21
Cyclen 28, Dermulen 30 21, Dermulen 30 28, Esme 21
Esme 28, Freya 21, Freya 28, Jencycla 28
Linessa 21, Linessa 28, Loestrin 1.5/30 21, Loestrin 1.5/30 28
Lutera 21, Lutera 28, Minestrin 1/20 21, Minestrin 1/20 28
Mirvala 21, Mirvala 28, Movisse 28, Mya 28
Ortho 0.5/35 21, Ortho 0.5/35 28, Ortho 1/35 21
Ortho 1/35 28, Ortho 7/7/7 21, Ortho 7/7/7 28
Ovima 21, Ovima 28, Synphasic 21
Synphasic 28, Tri-Cyclen 21, Tri-Cyclen 28
Tricia Lo 21, Tricia Lo 28, Triquilar 21
Triquilar 28, Yasmin 21, Yasmin 28

Emergency Contraceptive Pills: Contingency 1, Plan B (made by Paladin Labs Inc.), Backup Plan Onestep, Transderm Nitro 0.6
Other methods: Depo-Provera injection

Not Covered

These are birth control methods that are not covered under OHIP+.

Newer oral contraceptive pills:

Cyestra-35 21, Diane-35 21, Indayo 91, Lo Loestrin Fe
Next Choice late pill – 2 tablets
Novo-Cyproterone/Ethinyl Estradiol 21
Reclipsen 21, Reclipsen 28, Seasonale 91, Zamine 21
Zamine 28

Contraceptive patches: Evra
Intrauterine devices (IUDs): Copper IUD
Jaydess (LNG IUS 8) IUD
Other methods: Nuvaring (contraceptive ring)

It’s Complicated

These are birth control methods that are covered under OHIP+ in some circumstances.

Mirena IUD:

This is covered if you happen to have a heavy flow during your menstrual cycle, and this is the reason for the prescription (other than its intended use as a birth control option).

Kyleena (LNG IUS 12) IUD:  Still under consideration for approval
Some oral contraceptive pills: Alesse 21, Alesse 28, Alysena 21, Alysena 28
Apri 21, Apri 28, Aviane 21, Aviane 28
Marvelon 21, Marvelon 28, Micronor 28, Min-Ovral 21
Min-Ovral 28, Plan B (made by Teva Branded Pharmaceutical Products)
Portia 21, Portia 28, Tri-Cyclen Lo 21, Try Cyclen Lo 28, Visanne, Yaz 28

 

Many of the oral contraceptives on the list above have generic counterparts that are covered by OHIP+ and are cheaper. Branded oral contraceptives cost more to cover. However, if your doctor has a specific health reason (e.g. allergies or other negative reactions) for prescribing one of the oral contraceptives on this list, you can get it covered by OHIP+. You should talk to your health care provider about these specific circumstances and whether or not you qualify.

****Heads Up****
  • If you live on the borders of Ontario with Quebec or Manitoba and your health care practitioner resides in either of these provinces, you can still get a prescription from them. They will fill out the required forms and submit them. You will receive a response from anywhere between 3 days to 6 weeks.

If you and your health care practitioner decide on a birth control option that is not on any of these lists, you can check on the Ontario Drug Benefit Formulary/Comparative Drug Index [Link] or the Check Medication Coverage page on the Ontario.ca website [Link], or you can check with your local Ontario pharmacist to see if they are able to cover it.

Alternatively, you can apply for the Exceptional Access Program (EAP) if you:

For more information about EAP, visit their website: ontario.ca/page/applying-exceptional-access-program

Once a person turns 25 they are no longer eligible to be covered for medications. However, depending on the circumstances, they can be eligible for subsidized medications. Anyone who may be turning 25 soon should speak to their doctors to come up with a plan for the future.

Resources

If you have questions about this topic, feel free to contact one of our peer educators. [Link]