One of our Canadian readers, George Harrower, felt American myeloma survivors and caregivers might be interested in learning a bit about what it is like to finance treatment in Canada.
George was kind enough to pass along his thoughts about navigating the Canadian health care system after being diagnosed with cancer:
I read you blog request for feedback on Financial Assistance. I don’t know if you intended to extend your coverage to outside of the USA. I know you have readers around the world, but it could be a daunting task.
Here in Canada, health care is a provincial responsibility, so there are 10 provinces and 3 territories with different rules and capabilities. I can speak directly for assistance in Ontario, which although complicated, is quite comprehensive if you can master the paperwork.
The first line of coverage is the Ontario Health Insurance Plan (OHIP) which covers all Ontario residents who are Canadian citizens or landed immigrants (plus a few other exceptions). This covers doctors visits, hospital stays and medications administered in a hospital and applies across Canada.
My second line of coverage is group insurance through my employer, although not everyone has such a plan and may have purchased private insurance or applied for the next level of provincial assistance. Group insurance may cover semi-private or private hospital rooms, ambulance service, injectable drugs (such as neupogen), and other drugs according to a formulary (list of approved drugs – often generics). Coverage for formulary drugs is at a higher percentage up to 100%, non-formulary drugs are covered to a lesser percentage.
If you do not have group insurance drug coverage, or if only a portion is covered by your plan, then there is the Trillium Drug Program which covers formulary drugs for Ontario residents, including the portion not covered by group or private insurance. The Trillium Drug Program has an annual deductible which is calculated based on approximately 4% of household net income, so you will pay a portion of the drug costs under this plan.
Finally, a special case in Ontario is Revlimid. Revlimid is dispensed under the Rev-Aid program and is covered by the Trillium program. In my case, here is how the payments work:
My group insurance covers 75% of Revlimid until I reach the maximum out-of-pocket expense at which point they cover 100%. With Revlimid costing almost $10,000 per month, I hit the out of pocket maximum in the first month. The portion not covered by group insurance is forwarded to Trillium, who apply the amount against my deductible. The amount that came out of the deductible is then forwarded to Rev-Aid, who pay the pharmacy for that portion. The net result is that I pay nothing for Revlimid as long as I can keep track of the paperwork. Most of the work is done by the pharmacy which is approved by Rev-Aid to dispense Revlimid.
As you can see, it is complicated and may be overwhelming for someone who is just going through the shock of a multiple myeloma diagnosis. My oncologist has, of course, much experience with the various programs and had me applying for Rev-Aid and Trillium 4 months before he was ready to start prescribing Revlimid. I have also been on two clinical trials which meant that the drug costs were covered by the trials, although cost did not factor into my decisions.
As for the financial stresses added to living with multiple myeloma, I am sure you will agree that I have far better financial assistance than many. Even so, the initial paperwork and the uncertainty waiting for approvals was stressful. On top of that, my company changed insurance companies in January, and so I had to work through the Revlimid rules for a second time in less than a year with the new carrier over Christmas and the New Year. Fortunately, so far in my treatment (4 years this weekend) I have not had to make the tough decision of dipping into retirement funds in order to pay for treatment. To reduce my wife’s future financial security in order to extend my life for a few years is not a choice I want to make, although I know what her decision would be.
I hope this information is useful even as a comparison against what is available to the bulk of your readers in the US. Let me know if you need anything further. I have lots of time on my hands…
Wasn’t that interesting? Let’s give George a well deserved round of cyber-applause for taking the time to share his well written perspective with us. Thanks, George!
Friday I will get you more links to American programs which may be able to help U.S. citizens get some financial relief.
Feel good and keep smiling! Pat