Project 462559

Canada remains the only high-income country with a universal healthcare system that does not include prescription drug coverage. Financial barriers to contraception have been cited as one of the reasons young Canadian females chose to use less effective methods of contraception, placing them at increased risk of unintended pregnancy. Understanding how access to drug insurance for contraceptives affects Canadian females and ensure they are not placed at a disadvantage because of unintended pregnancy and subsequent physical and mental health outcomes. In January 2018, the Ontario government introduced universal pharmacare for all prescription drugs, including contraceptives, listed on Ontario's public drug formulary to all Ontario children and youth under the age of 25 without copayments, including individuals already covered via private drug plans (OHIP plus). In April 2019, OHIP plus was revised to cover those who did not otherwise have access to private drug insurance (OHIP minus). While OHIP minus continued to provide free drug coverage to Ontarians under the age of 25 without alternate forms of drug insurance, many Ontario youth reverted back to their previous private drug plan or, in many cases, their parent's private drug plan. Confidential access to prescription medication for these individuals may have been compromised and copayments were reintroduced. Our objective is to investigate whether OHIP plus/minus impacted long-acting reversible contraceptive use, abortion use and birth in Ontario females under 25 years. Using secondary data extracted from administrative databases, we will use two analytical designs to examine the impact of OHIP plus/minus, time-series event analyses and difference-in-differences approaches. Our project will generate policy-relevant evidence regarding the impact of free and confidential access to contraception for policymakers and advocates as Canada continues to evaluate how best to provide drug coverage for all citizens.