Effects of the COVID-19 pandemic on the number and characteristics of public drug program beneficiaries in Ontario, Canada

Introduction — In March 2020, the provincial government of Ontario, Canada enacted emergency public health measures to limit SARS-CoV2 transmission, including non-essential service closures, which contributed to substantial job and earnings losses. Concurrently, the federal government introduced temporary income benefits for Canadians with lost earnings due to COVID-19. We evaluated the collective effects of the COVID-19 pandemic, provincial emergency measures, and temporary federal income benefits on the number of Ontarians qualifying for public prescription drug insurance as provincial social assistance recipients over time.

Methods — Using administrative data from January 2019–March 2021, we conducted interrupted time series analyses of Ontario Drug Benefit (ODB) beneficiaries aged <65 years qualifying as Ontario Works (OW) or Ontario Disability Support Program (ODSP) recipients. We used segmented regression models to estimate joint effects of the COVID-19 related interventions, which were first implemented in March 2020, on the monthly number of ODB beneficiaries receiving OW or ODSP benefits. Senior ODB beneficiaries (all Ontario residents aged ≥65 years) were analyzed separately as a control series.

Results — Post-implementation, the interventions were associated with an immediate absolute increase in the number of ODB beneficiaries qualifying via OW (19,025; 95% CI=9,265–28,784) and gradual absolute reductions in the number of ODB beneficiaries qualifying through OW (-5,680 per month, on average; 95% CI=[-7,857]–[-3,502]) or ODSP (-1,993 per month, on average; 95% CI=[-2,500]–[-1,486]) beyond pre-implementation trends. Overall, the interventions were associated with 49,135 fewer OW beneficiaries (95% CI=[-75,175]–[-23,095]) and 20,356 fewer ODSP beneficiaries (95% CI=[-26,821]–[-13,891]) than expected in March 2021 had the interventions not occurred. The interventions were not associated with meaningful changes in the senior (control) series.

Conclusions — Despite job and wage losses due to the pandemic, we observed gradual and overall decreases in the number of ODB beneficiaries qualifying as social assistance recipients in the first year of the COVID-19 pandemic, presumably due to the introduction of temporary federal income supports to help workers recover lost earnings. Further research should examine how withdrawal of federal income supports may have contributed to subsequent gaps in public drug coverage among low-income adults and families in Ontario.