Canadians who have applied for coverage from the Trillium Drug Program

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Robert.K
Regular Member


Date Joined Nov 2007
Total Posts : 137
   Posted 12/4/2007 9:32 PM (GMT -6)   
Hello everyone,
 
This post is a question for fellow Canadian patients of UC who have applied for prescription drug coverage from the Trillium Drug Program. I have recently applied for the TDP and am awaiting a response. I have been advised by an agent from the TDP help line that it takes up to 10 business to process an application after its reception if proff of income has not been provided.
 
I am looking for assistance from the TDP to help me pay for treatment with Remicade. I currently have insurance from Manulife (provisioned through my employer) which will cover me for 80% of the cost of the drug. This will still leave me with a 20% share, around $800 per infusion. I cannot currently afford this medication, as I am still a student and earning around $10 000 - $12 000/year as a part-time employee. I have earned significantly less this past year due to a lot of time taken off due to severe illness, as I'm sure many of you understand.
 
I have been advised that the TDP does not cover the cost of Remicade, however there are special applications that can be filled out by health care professionals to apply for coverage for Remicade (and other drugs not covered by the TDP). This special section is called section 8 (and/or section 16). Does anyone here have any information they can share with me regarding how this process works and what the timeframes for processing are?
 
I have been advised by an agent from the TDP help line that section 8 can take up to two months to process (too long to wait!). When I contacted the TDP via email, I was advised that in order to inquire about the timeframe associated with the processing of section 8, to speak with my health care provider (nurse and/or doctor). I have been in touch with a local Remicade nurse, who will be in touch with my specialist in order to get the medical records she needs to request special access for myself to receive coverage for Remicade. She advised me to have a TB test and chest x-ray fulfilled, both of which I completed today.
 
I'm curious if anyone in here has used the TDP, and what their experiences were like? More relevant to my situation, though, would be any personal anecdotes regarding the TDP and special application for normally non-covered drugs like Remicade via submission of a section 8. If it means anything, I live in Ottawa, Ontario. Hopefully, they will process my application expeditiously as I am currently flaring HUGE and would love to try out this new drug as quickly as possible. I'm hoping it is the answer I've been looking for, as I've been sick for the majority of the past two years with varying levels of flaring. Lastly, I was advised by the nurse that the TDP treats UC patients differently than Crohn's patients when it comes to applications for coverage for Remicade. To quote the nurse: "It's be better if you had Crohn's!". What she meant was that Crohn's patients generally have an easier time getting approval for coverage from the TDP for Remicade, and that they get approced for longer periods of time. For example, she told me that Crohn's patients generally get approved for 6 - 12 month timeframes from Remicade, whereas UC patients get approved for 2 month timeframes and need to subsequently re-apply.
 
I hope my post is clear and easy to understand. Thanks!

pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20577
   Posted 12/4/2007 11:31 PM (GMT -6)   
acrobat
Regular Member


Date Joined Oct 2006
Total Posts : 46
Posted 11/27/2007 8:50 PM (GMT -7)
pb4 said...


And regarding the approval on the remicade that's true because the cost of it here (where I live) is around 1000.00 for one month, out of our pocket (at least it was a few yrs ago, it may have changed now and there may be some subsidy on it now but you can bet that the majority still comes out of the patients pocket for remicade).

:)


I also live in Alberta. I started remicade today and only paid $11 when I picked it up at the pharmacy....



I copied this post as "canadian health care" was being discussed at the crohns forum here at HW...apparently as you see this poster "acrobat" lives in Canada (specifically in AB) and apparently only pays 11.00 for his remicade so maybe you could post to him/her over at the CD forum and get more info on how he/she gets it so cheap.

:)
My bum is broken....there's a big crack down the middle of it!  LOL  :)


Crohns fighter
New Member


Date Joined Apr 2008
Total Posts : 4
   Posted 4/25/2008 2:25 PM (GMT -6)   
Hi Robert,
I am on the same boat here in Toronto confused .
Were you finally able to get drug coverage for Remicade through TDP?
What help did the Remicade coordinator provide in accessing the coverage?
What information did you have to provide to the Remicade coordinator?
How can one get in touch with a Remicade coordinator - are they located in physician's office?
Not mine at least.
 
Is it possible I could talk to your over phone? yeah
Crohn's Fighter
 

Sideshowbob
Veteran Member


Date Joined Sep 2005
Total Posts : 698
   Posted 4/25/2008 3:02 PM (GMT -6)   
Health care coverage is a bit different in each province. In my province (Manitoba) we have Pharma care which after a deductible is satisfied (it is approximately 5% or so of your gross family earnings), the government pays the entire cost of drug coverage. So for instance, if my deductible is $4000.00 each year (from April 1 to March 31), I pay the first $4000.00 of ALL prescriptions for my ENTIRE family, and then the government pays the rest of our family prescriptions (100%) for the rest of the year. And if you have private insurance, whatever they pay counts towards your deductible. So for instance, I have 90% coverage through my wifes employer, so (with a deductible of $4000.00) I will pay $400.00 out of pocket for the year, and then nothing else.

Now, if the drug is not covered by your private plan or by Pharmacare, your doctor can apply for what is called EDS 3 status (Exceptional Drug Status) to get it covered. What this is, is that the doctor is saying that the generic forms, or other available drugs, will not work for your condition. Thats how I have a few of my scripts covered.

Hope this helps! :)
35 year old Male, Husband, Father of the best three kids in the universe.
First Flare was February 2005. Diagnosed June 2005-left-sided Colitis, suspect it has since spread. Started 4000 mg Oral Salofalk June 2005-stopped January 2007. Remission until November 2006. Been in a flare to various degrees since November 2006 to February 2007. Currently in remission.
Presently on 0 mg Prednisone-down from 60 mg!
Weekly 4000 mg Salofalk enemas.
Daily 4000 mg Salofalk oral.
Started Omeprazole 20 mg February 2007.
Co-Moderator-UC Forum


Crohns fighter
New Member


Date Joined Apr 2008
Total Posts : 4
   Posted 4/28/2008 10:46 AM (GMT -6)   

Thanks! this is indeed very helpful. However, for Ontario province - does anybody know how the drug coverage works for Remicade? Does TDP (Trillium Drug Plan) provide coverage for Remicade? What forms do you or the doctor will have to fill? What is the criteria for TDP to approve Remicade coverage?

What support was provided by a "Remicade coordinator" in getting the drug coverage and coordinating the infusion.

Thanks

Crohn's Fighter


dodge08
Regular Member


Date Joined Feb 2009
Total Posts : 31
   Posted 5/5/2009 1:40 PM (GMT -6)   
We have been going through the process for the last few months -- I get 80% thruogh my wife's benefits (Sunlife) and then I have received some funding through the Remifast program (temporary) until the Trillium comes through - I know the deductable for Trillium can be quite high, so we may have to pay for a few infusions first...the good thing about Trillium is it will count the whole families prescpritions towards the deductable I think.

I'm in Ottawa as well.
Male 38, diagnoised in 1998, first major flare in November 2008, have had 2 remicade infusions
have used pentesa, salofalk pills (mesalamine), and enema's.
Started salofalk again until I can get my next remicade.
currently decreasing predisone, take folic acid, calcium, vitamin D, HMP powder and a multi vitamin


cheeky22
Regular Member


Date Joined Jun 2008
Total Posts : 20
   Posted 5/6/2009 9:30 AM (GMT -6)   

Hi robert

This is how it works for me:  I have coverage through work (sunlife) which pays 80%...the cost of my Remicade every 8 weeks is $4800.  The pharmacist bills Sunlife for me so that they re-imburse him.  I pay $150 to him when I pick it up and RemiFAST was picking up the rest. 

RemiFAST is an assistance program to help with the cost but you have to be Trillium registered as RemiFAST assists with your deductible that you have with Trillium.  I got into a bit of a mess because RemiFAST was covering what I didnt pay I did not submit to Trillium...just recently though RemiFAST contacted me and they are only willing to pay a small portion to assist with my TDP deductible so as of now I have to pay more out of pocket but then I am re-imbursed by TDP.  The pharmacist that I use is very good and I still only pay him $150 when I fill the prescription then I have the 8 weeks until my next one to pay him the remaineder which I get back from Trillium.

You should have been given a name of someone to assist you with your Section 8 (or 16...they call it both) because they work with the doctor to get the approval for the Remicade.  It only took about 1 week to get my first approval, and then my Remicade co-ordinator re-applies every 2 months for me.

It really sounds more confusing than it is....best advice get a co-ordinator (your dr should have that info), get a pharmacist who is willing to work with you on payments, request assistance through RemiFAST, get your Trillium approval and make sure that you submit all of your receipts to them.

If you have any more questions, let me know.

Kelly

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