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Paying for Biologics in Canada

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Ulcerative Colitis
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jin
New Member
Joined : Mar 2016
Posts : 4
Posted 10/11/2016 9:40 PM (GMT -7)
After 4 months of symptomatic remission after a course of Prednisone, my symptoms are back and my GI is talking biologics. I'm aware of the risks, and after being in a flare for 15 of the last 20 months and several failed meds I'm exhausted and ready to go down that road.

My extended health benefits through work would cover 80% of the cost, but I'm no position to cover 20% out of pocket. My GI works in a research facility and, when I mentioned my concern, said he's fortunate to be able to arrange no-cost biologics for his patients - and not through a clinical trial. I'm worried he assumed I don't have benefits and would therefore be eligible for medication from drug companies through their compassionate care programs. I should have clarified but I didn't, and I won't have an opportunity to clarify with him for another 2 weeks.

Does anyone have helpful information for me? I don't think the medication he's leaning toward is covered via Pharmacare. Are drug companies compassionate care programs available to people with benefits if we can't afford our share?
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U B Tough
Veteran Member
Joined : Aug 2015
Posts : 1155
Posted 10/11/2016 10:14 PM (GMT -7)
HI Jin,

I have 80% coverage and my biologics are still covered by compassionate grounds, Ohip, hospitals etc . I'd guess that for most the 20% balance would be a hardship. There's also the Trillium drug Program which you can apply for.

I'd suggest calling your GI and explaining you have partial coverage but need help with the rest. Don't wait until you see him. Biologics & paperwork can take time & you don't want to delay the process.

Good luck!
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Richard in NY
Regular Member
Joined : Nov 2012
Posts : 208
Posted 10/12/2016 4:36 AM (GMT -7)
In the US the pharma that makes Humira has a program to cover most of your co-pay. It would be worth a call to find out if it applies in Canada as well.

/www.humira.com/humira-complete/cost-and-copay

Post Edited (Richard in NY) : 10/12/2016 6:28:58 AM (GMT-6)

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Tortured
New Member
Joined : Sep 2016
Posts : 19
Posted 10/12/2016 11:36 AM (GMT -7)
If anyone in canada is on Entyvio can you please tell me how much it costs per infusion and if you have to pay any of it? Especially if all you have is OHIP and no other coverage or insurances?

Thanks
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U B Tough
Veteran Member
Joined : Aug 2015
Posts : 1155
Posted 10/12/2016 12:17 PM (GMT -7)
I forget the cost but likely a couple of thousand like most biologics.
Yes, you can get it just with OHIP. Your GI & drug company work together to get it covered. Cost isn't nor should it be an issue. If you haven't applied for Trillium Drug program is recommend it as its a lengthy process.
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jin
New Member
Joined : Mar 2016
Posts : 4
Posted 10/12/2016 7:30 PM (GMT -7)
thanks for the information and peace of mind, everyone! i'm glad $ isn't preventing any of you from getting the care you need.

be well.
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U B Tough
Veteran Member
Joined : Aug 2015
Posts : 1155
Posted 10/12/2016 10:09 PM (GMT -7)
You're welcome Jin. I hope it works out for you!
At one point my IVIG treatment was running upwards of $30000/mth. I'm grateful beyond words for our health care coverage. I never paid a cent. Even when I needed a nurse to visit, it was at no cost to me.
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jujub
Elite Member
Joined : Mar 2003
Posts : 10422
Posted 10/12/2016 11:29 PM (GMT -7)
I'm not familiar with the Canadian system, but in the US if you have any insurance that's government-funded (such as Medicaid, Medicare, etc.) you aren't eligible for the pharmaceutical company assistance programs. The reason is complicated and I don't understand it even after it was explained to me twice, but that's how it is here. I hope it all works out for you.
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