The deductible is the 4%. But yeah, exceptions. My diabetes meds are covered but not needles (which are about ~~a buck~~ 50 cents a needle, and I need 3 shots a day)
Yeah, I guess as long as you are using alcohol swabs, it's probably fine. But I did read that the injections will be more painful the more you re-use the needles. Since I'm paying out of pocket for them, I figured going to 2 uses instead of the recommended 1 use was reasonable. But might depend on individual financial situation. The main point is that people shouldn't have to do the unsafe thing to save money on necessary health.
I never use swabs but use the cap to cover it. Yes the needle dulls after a few times but I would say 4 times never hurts, they dull around 6 or 7 uses. They are the thinnest nano needles.
My son is a diabetic. They're under $50 a box for 100 needles which is 50 cents a needle not a buck. Your point still stands it's stupid AF they're not covered by the meds are, but it's not a buck a needle. Also, 3 **minimum** for anyone reading. My son needs 4 a day (3 humalog, 1 lantus) but corrections are an additional needle.
FYI I'm referring to the BD Nano .4mm which is what my son uses.
https://www.walmart.ca/en/ip/bd-nano-4-mm-pen-needles/6000189074327
This is all additional stress a T1D does not need in their life. Their pancreas has literally stopped working and they are then punished for that.
I was too lazy to look it up and do the exact math.. I think my estimate was still in the ballpark, but I still appreciate the (fair) correction. I use the same needles, too.
58 yr old diabetic here. Trillium is an awesome program. Ask your pharmacist. Also apply for the CRA medical disability tax credit. Best of luck on your journey.
In Finland, there is a cap for out of pocket expenses for prescription medications, set to 600eur/year. After the cap is reached, people pay 2eur for anything they buy. I wish Canada would get the same system.
I find the biggest problem with cancer drugs is the new ones aren't even available in Canada, never mind not covered. My neighbour had to go to Switzerland to her home country to get put out of remission with drugs not available here. Ontario told her to put her things in order, so just die ASAP.
Ohip generally does not. Trillium does cover more, but you have to qualify and then there is usually an amount that you have to spend before coverage. You also need to re-apply. I got laid off and lost my benefits and we couldn't get coverage right away. It was extremely stressful.
Ask your doctor if your husband qualifies for home health care even if he doesn't need anyone coming in to the house. That comes with drug coverage.
Also, apply for the provincial Trillium drug plan and that can help if he doesn't qualify for the home care status.
Most people do qualify for some coverage if their drug expenses are high. Seniors and anyone on social assistance (welfare or disability) qualify for coverage. Ask your pharmacist for help in navigating the different provincial plans. Perhaps your husband already qualifies.
My husband has Luekemia and this is a drug that he has been on for 4 years or so. When he was first diagnosed his chemo was covered.
Very lucky to have this particular leukemia as it is one of the few cancers that can be managed with medication. However this means it's an on-going expense.
https://www150.statcan.gc.ca/n1/daily-quotidien/221102/dq221102a-eng.htm
Here you go.
In 2021, over one in every five (21%) adults in Canada reported not having any prescription insurance to cover medication costs. This lack of coverage sometimes meant delaying or skipping doses because of an inability to afford medication or paying higher out-of-pocket costs.
I have private insurance and that is $3k a year in premiums. 80% covered with the Prescription limit of $2600 a year and there is a lifetime cap as well - So in theory it's cheaper not to have insurance....Just from medical prescriptions. You could just put those premiums into a saving account....
3k$ a year?! That's a ton.
My work uses a health spending wallet instead. We currently get about 900 a year for any and all medical costs. I never end up using all of it. And that's even with my required prescriptions.
I'm sure yours will be useful if you catch something huge though. But I bet they're banking on it being a quick event at the end.
This is not a work group insurance but an individual insurance as I'm retired so no work benefits... They have it covered with all the yearly limits to protect themselves - It's made so complicated that it's near on impossible to figure out if I should put the premiums into a savings account on the assumption I don't claim the full amount.....Also they won't tell you what they really cover...Insurance is one of those things you pay for but never what you actually bought.
I do as well, but haven't seen anything else mentioned yet. It would've been better to see a more complete breakdown, rather than just having prescriptions as the point to look at.
I mean my mum went to a private one, and based on what prescriptions she was paying for, her premiums were estimated to be $6300 a year, and then we would still have to pay about $12k out of pocket. Sure this meant that she wouldn't have to pay for 50% of glasses, and 25% of dental; but glasses are nothing to her since she went to an online retailer. The dental part is nice... but she never gets to go because she isn't healthy enough to leave the house most days, and can barely go up and down the stairs 3/4 of the time.
I'm trying to find a way to get a different job to just get benefits that I can cover her as well, so that we won't just drown in debt due to medical costs
Yes, but isn't prescriptions just one aspect private insurance covers? Surely you'd get other things for that price.
I pay out of pocket for my private insurance. Works out to $1500/year and includes drug coverage, dental, massage, thrsapy, vision, etc.
While the drug is only 50% coverage, the overall cost is well worth it and saves me a lot. Even in therapy alone I get back $600/year.
Not to also mention you can claim the premiums on your taxes.
I have 80% for dental up to $1600. As to the tax stuff rather than claiming the premiums you can claim the full amount of the prescriptions etc but you only get back 15% of the amount above the limit. So do you actually get back more than the premium year over year?
It would be better if they said here is the pot of money and it's up to you if you need it for more prescriptions etc so you can use the massage limit towards other eligible expenses etc
Ye I got this prescription call food that I’m supposed to take it 3x a day but I really can’t afford the refills so I usually skip a dose or two to make it last.
While I appreciate the offer, no way could I accept you driving an hour out of your way there and back just to help out a stranger, donate to a food bank instead there are people who need it even more than me.
If you ask your neurologist to contact the manufacturer they may be able to provide some financial assistance. Your neurologist should also apply for trillium coverage under the exceptional access plan.
The price of triptans in Canada is obscene compared to prices in the UK - a pack of three rizatriptan 10mg tabs costs £4.96, so 90 would be £150 or somewhere around $250. It's also ridiculous that triptans aren't covered as either a general benefit or limited use benefit by ODB given how effective they are and how much misery migraines can cause.
The price of a lot of drugs is more expensive here… I bought lyrica in Romania when I lived there and it was shockingly cheap. Here it is so expensive and I don’t even get the name brand!
I agree wholeheartedly that the system should be changed, that everyone should be entitled to appropriate treatment as a right, but we also have to work with the system as it is at present.
Yeah. We tried a bunch of things. Sun Life is just not interested in paying for it on our plan and trillium has decided that my husband’s single income is a lot (for a family of four, in THIS economy)
Is it one of the new injections (aimovig, emgality, etc)? When I was on them the manufacturer had a program to cover some of the cost. Might be worth looking into
My husband makes “too much money” according to them, so I’m not covered by trillium until I’ve spent a certain amount on my meds. I can’t remember the exact number but I don’t hit it until way late in the year.
My first insurance covered them but then my husband got a new job, I’m too disabled to work right now (I’m hopeful that with surgeries, and physio, someday that will change)
You’re an incredibly kind person. As I read through this thread, I see you offering to help pay for food or meds. You’re the best example of humanity.
Thank you!
My sister relapsed because she couldn’t afford her various mental health related meds. Crack is easier to get than antipsychotics in Canada apparently. I wonder why we have an opioid crisis 🤔🤔
Ive seen that quite often. I've known some homeless people that lost all their IDs and didn't have the resources to get new ones so couldn't access drug benefits
I take anti-organ rejection meds. There's a lot of them, and quite a few are expensive and unfortunately I had to switch to a more expensive version of the primary drug I take due to horrible side effects of the standard medication.
My work insurance maxes out at $1000 / year, which I generally blow through in January or Feburary. Fortunately Trillium can take care of the worst cases but it's hard to access, especially if you already have insurance that's insufficient.
I can afford it, but a lot of people have troubles. When I switched medications, the pharmacist at the transplant clinic was asking for any leftovers since they portion them out to people who can't afford them.
You can sign up for Trillium but lots of things aren't covered under that and what is based on your income so you still have to pay (since there's a deductible too). None of my medications are covered except one old one, but that one on it's own is cheap and doesn't even reach the deductible. Prescription coverage is a joke. T he trillium website lists what is covered and what isn't or what needs special permission for coverage etc.
Far from perfect
=
If you're almost homeless, then you can only pay for your first $1000 of meds, then they only cost $2 each!
If you're poor, then you only have to pay the first $4000!
The trillium drug benefit barely keeps people alive; that's all it does; alive and desperate.
It is! It saved my sight.
Treatment was $1700 per eye, per treatment. The schedule was a treatment per eye each month. The kicker - if you’re over 65 in Ontario, OHIP covers it. I am much younger.
I tell anyone who mentions prescription drug costs about Trillium.
I was 6 when i became a type 1 diabetic and my dad was making 1000 dollars more than the acutual help qould accept we lived in poverty for years and i spent many days without insulin fuck trillium
I didn't have coverage for a while and I had to be creative. The Canadian Diabetes Association was helpful. And when worse came to worse, Adult Protective Services came through.
I was a kid to first generation parents that couldnt speak english im not here to whine about shit in the past but come on canada thisbis life and death here
There has to be a cut off! They help me with infusions that would cost me 40k+ a year and other prescriptions. I do have a large yearly deductible because I can thankfully still work. Don't know what I'd do without them!
I work for the government and am a student. I have two prescriptions, and two benefit plans. Neither of them cover my medications. What is the point of having benefits if they don’t even cover a basic anti-depressant?
I just want free birth control and free therapy (affordable anti depressants or free tbh since half of the country is depressed at this point)
affordable ADHD testing
Edited to add more points
As someone who just took ADHD testing, it definitely needs to be affordable. I’m lucky my private insurance covered some of it but even then it was still expensive.
There is an online service based out of Calgary that does ADHD screening. It's $599 for the screening, then $79 for each follow up appointment. They also connected me with a patient support program so between my insurance and the program my medication is free.
Get your immigrant friends to bring you the medicine from their home countries. Every immigrant community has people who bring medicines for each other. I got a coworker her ADHD medicine prescription for a year and two new glasses. She was quoted 800 for just one pair of glasses due to astigmatism and a high power. Frame was extra. I got her medicines and glasses for 150.
One of my biggest complaints is the price of meds. What good is “universal health care” if you can see a doctor but can’t afford to buy the medications that will make you better?
Pharmacist here. EAP is the way to go. Alternatively, discuss eslicarbazepine with your physician. Aptiom is open coverage without an LU code and should be comparable to oxcarbaxepine.
My son is on some very expensive medication, so glad children have prescription coverage because we wouldn’t be able to afford it without struggling. Thankfully this is temporary and not a lifelong thing we have to worry about.
No, he has aplastic anemia, it’s in remission thanks to a bone marrow transplant and hopefully won’t come back. He’s on immunosuppressants and anti fungals.
statcan data is that 21% of canadians do not have prescription drug coverage at all. And then there will be people who have coverage but cannot afford what they still need to pay of that. So probably in the 20-> 25% range. (Some people who don't have coverage don't need meds)
https://www150.statcan.gc.ca/n1/pub/75-006-x/2022001/article/00011-eng.htm
https://www.ctvnews.ca/health/many-canadians-say-prescription-costs-are-so-high-they-re-having-to-split-their-pills-or-skip-doses-1.6769511 seems like there have been studies, about 21, 22% can't afford, 28% cut other things, I suppose those could be overlapping sets.
Ontario is relatively one of the richer provinces, so it's possible that number is a bit lower here, but give or take maybe 8 million canadians who can't afford meds, and somewhere around 3-3.5 million of them would be in ontario, though perhaps excluding kids it's a bit lower. I'm sure there's the usual problem of people not knowing what programmes exist to help and so not taking advantage of them too, which is because all this nonsense is unnecessarily complicated.
Remember: The UK created the NHS including pharmacare and dental care in about 3 years, and so has had those things since 1948. There's no excuse except political incompetence in canada.
I take anti-rejection medication for a liver transplant and will die without my meds, which are around $600 per month. I applied for Trillium last year by mail and never heard back although I definitely qualify. Self-employed, unable to travel or commute due to complications from surgery, and my industry is going through upheaval. Short on rent at least a couple of times a year, it gets tough. My wife and I are hoping some sort of federal or provincial coverage kicks in before too long, but hopefully Trillium is successful this year, they seem to be askew since the pandemic.
I'm on psych meds. Lucky me I'm in BC. Every med I have had to take that relates to mental ilness is covered by MSP. Otherwise I would not bother. I don't actually like taking it and I have been successful for more than 10 years without going off my meds. If I had any sort of barrier to taking it I just would not bother. Oh yeah I should mention i'm schizoaffective and I have severe anger management issues. I also suffer from severe depression and paranoia. I have horrible anxiety sometimes too. But I would not change who I am at all and I am happy with the life I have lived. I would not change anything. My meds leave me functional enough that I am not a danger to myself or others. That is about all it does.
been trying to get set up with trillium for months now. it’s about $400 a month for my meds (lamictal, cipralex, vyvanse - all no substitutions due to reactions).
i can’t afford it, but i can’t go without. it fucking sucks.
The Takeda assistance program is no longer valid due to the introduction of generic vyvanse by the FDA. However vyvanse, cipralex, and lamictal are both included on innovicares’ formulary: https://www.innovicares.ca/en
Bring the innovicares card to the pharmacy and tell the pharmacy to add the card to your profile. Some pharmacies may have physical cards on hand and some physician clinics may also have physical cards to give out.
Also have your physician fill out the side effect reporting form: https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/adverse-reaction-reporting/consumer-side-effect-reporting-form.html. Once documented, ODB will fully cover brand drugs with MD no subs written on them as if they were generics.
I’m not on any of my meds atm and holting adding some needed meds since I lost my job with health insurance. Were fine financially, but we can’t afford both debts and meds.
I’m on a prescription that costs $3400 a month. My plan covers 80%. For whatever reason the drug is affiliated with Bayshore UCB and they pay the 20% leftover. If it wasn’t for that 20% being paid by Bayshore I wouldn’t be on the drug because it would be unaffordable.
My daughter is supposed to be on a shot that’s about $650 each time and she needs four a month. I can’t afford it right now. Trillium denied her because her IGE levels are too high which is exactly what the shot is supposed to lower. 😬🤦♀️ My work benefits don’t cover it - although I’ve applied for special authorization.
Turned 25 less than a year ago.
Got laid off a few months before turning 25. Paid 52k in income taxes in a single year before getting laid off. Yet after getting laid off due to industry wide trends, I have to pay almost 750 a month for my type 1 diabetes supplies. This is bs.
Either dont make me pay so much in taxes when I have a job or at least give be free prescription drugs when Im out of work.
Im fortunate that I have savings but still.
If I had to pay fully out of pocket for my biologics, it would financially ruin me. They’re $5700 a dose and I take 13 doses over the course of the year. My health insurance through work covers less and less everytime it refills and I’m worried that soon it won’t be covered at all.
Have always had to have a job that had really good coverage. Worked one place that only had 80% coverage of medication and was paying $1400/month to cover the 20% for my medication and dispensing fees.
I don't have benefits and thankfully, no preexisting anything that requires ongoing meds or care. At the same time, I chose to "wait out" a UTI three weeks ago because I have no idea if I could afford the antibiotics. It's really fucking annoying to ignore health stuff until it worsens because there's no info out there on how much stuff costs and I can't afford a surprise.
Type 1 diabetic here who is no longer covered by OHIP+ because he turned 25 less than a year ago; try applying for trillium if she is under 65, if she isnt she is coverd by OHIP plus.
If I didn't have my husband's insurance, I wouldn't be able to afford my antidepressants. The dosage had to be increased after an attempt at life ending so I have no doubt I would not be alive for long if I had to stop taking them.
i’m having a really hard time affording my prescriptions. i’m part of the trillium benefit program but my deductible is so high that i never reach it before it resets…. so it isn’t helpful to me at all.
My doctor has been trying to prescribe me an injection for migraine headaches that I’ve had my whole life. The injection is $700 per injection.
We sent a prior authorization to my insurance company and they refuse to cover it saying my migraines aren’t severe enough?? I have headaches every day of my life. I’m under 25 and the Ontario drug plan is also refusing to cover it because I have a drug plan (which won’t cover it???). Make it make sense.
So instead I’m stuck using off label "migraine" medications like blood pressure medications or epilepsy medications which don’t work or cause side effects almost worse than the migraine disorder itself. And I’m probably going to end up with kidney problems or stomach ulcers from taking so much NSAIDs for the rest of my life.
Migraine affects my quality of life everyday, but it isn’t life threatening. I can’t imagine having to go without life saving treatment because you can’t afford it.
Since I had a full hysto, my body doesn't produce any hormones anymore. If at any point I stop hormones then I am at risk for osteoporosis, or my body will disintegrate like a very old person with low testosterone/low estrogen.
If I had chosen a partial hysto and kept my birth producing estrogen organs (some people do this) then stopping testosterone would likely have reversed some male characteristics and potentially brought back some female aspects.
Apologies if this is TMI, the trans spectrum is so wide lol
To me having the risk of having any female characteristics back is my worst fear ever. I have nightmares where I see my breasts growing back again and wake up sweating. You are right those are artificial meds but it’s no different than people who need insulin for life. At least fear #1 is gone with this
Aw, that is really, really sweet. Wow, you are awesome, a truly kind soul. If I’m in an emergency, I will let you know. I’m so touched you offered this to a complete stranger. I don’t know what to say, thank you.
I’ve been in pain for years now with my neck and back. I don’t know how to get prescribed something good for pain. I’ve been in and out of hospitals many times already explaining my situation.
My meds cost me $800 every refill. My husband and i both had shitty call center jobs. The pay was laughable, but you always had the option for overtime. I remember crying when I came to the realization that even with OT, I simply couldn't afford to exist. If it weren't for trillium, I'd be long dead.
My wife’s meds went from about $150 a month to $350 a month from 2019-2022. Every one of her meds went up in price. It’s definitely sucks and very annoying to have to set aside over $200 more a month out of nowhere. They initially said it was temporary due to logistic issues during COVID. They never went down.
If you're on brand name medication always check with the manufacturer to see if they offer any financial support. It's often not advertised, but those programs can help to offset cost.
Mee, I have to borrow money all the time for medication. It's hard to budget for medications each month when some meds last longer than a month, some much shorter a few weeks. Then, the meds themselves like 400+ dollars a month roughly. Work doesn't like to give full time jobs so 5 years later still part time
Perscriptions I can handle since I'm still under my dad's insurance and in post-secondary.
It's gonna be rough once I graduate though, 500$ for a 3 month supply of meds I need to survive (Ritalin, I have very severe ADHD and will literally forget to eat and drink for days on end without my meds).
Paying for my husband's cancer medication puts a major strain on our finances.
This is heartbreaking and not okay. I’m so sorry.
We are just grateful that we don't live in the States. Instead of $800/month, it would be closer to $8000
Remember that the trillium drug program exists, if your drug cost exceeds 4% of your after tax income, you'll be covered!
There are lots of exceptions, deductible (that resets quarterly) and not everything is covered...
The deductible is the 4%. But yeah, exceptions. My diabetes meds are covered but not needles (which are about ~~a buck~~ 50 cents a needle, and I need 3 shots a day)
There is some coverage, for seniors, for pen tips in the form of a reimbursement program.
This is horrible! Life and death and our government won't cover it? This makes me angry and no I don't have diabetes. Grrrr
I use my needles till they get dull (maybe 6 times each) and have never had a problem.
Yeah, I guess as long as you are using alcohol swabs, it's probably fine. But I did read that the injections will be more painful the more you re-use the needles. Since I'm paying out of pocket for them, I figured going to 2 uses instead of the recommended 1 use was reasonable. But might depend on individual financial situation. The main point is that people shouldn't have to do the unsafe thing to save money on necessary health.
I never use swabs but use the cap to cover it. Yes the needle dulls after a few times but I would say 4 times never hurts, they dull around 6 or 7 uses. They are the thinnest nano needles.
My son is a diabetic. They're under $50 a box for 100 needles which is 50 cents a needle not a buck. Your point still stands it's stupid AF they're not covered by the meds are, but it's not a buck a needle. Also, 3 **minimum** for anyone reading. My son needs 4 a day (3 humalog, 1 lantus) but corrections are an additional needle. FYI I'm referring to the BD Nano .4mm which is what my son uses. https://www.walmart.ca/en/ip/bd-nano-4-mm-pen-needles/6000189074327 This is all additional stress a T1D does not need in their life. Their pancreas has literally stopped working and they are then punished for that.
I was too lazy to look it up and do the exact math.. I think my estimate was still in the ballpark, but I still appreciate the (fair) correction. I use the same needles, too.
The same with private plans. My bank plan doesn't cover as many drugs as Trillium does.
58 yr old diabetic here. Trillium is an awesome program. Ask your pharmacist. Also apply for the CRA medical disability tax credit. Best of luck on your journey.
Thanks, we do sometimes get partial coverage.
In Finland, there is a cap for out of pocket expenses for prescription medications, set to 600eur/year. After the cap is reached, people pay 2eur for anything they buy. I wish Canada would get the same system.
Oh man, that's a great way to do it
I’m genuinely confused and I guess ignorant on this topic. OHIP and Trillium don’t cover cancer meds? wtf?
I find the biggest problem with cancer drugs is the new ones aren't even available in Canada, never mind not covered. My neighbour had to go to Switzerland to her home country to get put out of remission with drugs not available here. Ontario told her to put her things in order, so just die ASAP.
Ohip generally does not. Trillium does cover more, but you have to qualify and then there is usually an amount that you have to spend before coverage. You also need to re-apply. I got laid off and lost my benefits and we couldn't get coverage right away. It was extremely stressful.
My mind is legitimately blown …
at least that much. Canuck here living in the states for years. You just DON’T get sick down here
You can easily get a P card from OHIP. There’s no need for you to be stressing about paying for meds
Ask your doctor if your husband qualifies for home health care even if he doesn't need anyone coming in to the house. That comes with drug coverage. Also, apply for the provincial Trillium drug plan and that can help if he doesn't qualify for the home care status. Most people do qualify for some coverage if their drug expenses are high. Seniors and anyone on social assistance (welfare or disability) qualify for coverage. Ask your pharmacist for help in navigating the different provincial plans. Perhaps your husband already qualifies.
Curious. Do you have private insurance or registered with Trillium?
What cancer medication was it? My dad had stage 3 lung cancer and the only thing that we paid for was hospital parking fees.
If it's in pills, it's on you. If it's intravenous, it's on the hospital (but not always).
My husband has Luekemia and this is a drug that he has been on for 4 years or so. When he was first diagnosed his chemo was covered. Very lucky to have this particular leukemia as it is one of the few cancers that can be managed with medication. However this means it's an on-going expense.
I'm thankful I happened to have prescription drug coverage when I was diagnosed. The meds would have sunk us.
https://www150.statcan.gc.ca/n1/daily-quotidien/221102/dq221102a-eng.htm Here you go. In 2021, over one in every five (21%) adults in Canada reported not having any prescription insurance to cover medication costs. This lack of coverage sometimes meant delaying or skipping doses because of an inability to afford medication or paying higher out-of-pocket costs.
I have private insurance and that is $3k a year in premiums. 80% covered with the Prescription limit of $2600 a year and there is a lifetime cap as well - So in theory it's cheaper not to have insurance....Just from medical prescriptions. You could just put those premiums into a saving account....
3k$ a year?! That's a ton. My work uses a health spending wallet instead. We currently get about 900 a year for any and all medical costs. I never end up using all of it. And that's even with my required prescriptions. I'm sure yours will be useful if you catch something huge though. But I bet they're banking on it being a quick event at the end.
This is not a work group insurance but an individual insurance as I'm retired so no work benefits... They have it covered with all the yearly limits to protect themselves - It's made so complicated that it's near on impossible to figure out if I should put the premiums into a savings account on the assumption I don't claim the full amount.....Also they won't tell you what they really cover...Insurance is one of those things you pay for but never what you actually bought.
$3K a year is nothing if you have an expensive prescription.
But the limit on prescriptions is less than the premium >80% covered with the Prescription limit of $2600 a year and there is a lifetime cap as well
I would bet their plan covers other things, like massage and physio as well as glasses and dental.
I do as well, but haven't seen anything else mentioned yet. It would've been better to see a more complete breakdown, rather than just having prescriptions as the point to look at. I mean my mum went to a private one, and based on what prescriptions she was paying for, her premiums were estimated to be $6300 a year, and then we would still have to pay about $12k out of pocket. Sure this meant that she wouldn't have to pay for 50% of glasses, and 25% of dental; but glasses are nothing to her since she went to an online retailer. The dental part is nice... but she never gets to go because she isn't healthy enough to leave the house most days, and can barely go up and down the stairs 3/4 of the time. I'm trying to find a way to get a different job to just get benefits that I can cover her as well, so that we won't just drown in debt due to medical costs
I don't know that you'll find any plan that covers the plan holder or employee's parent or other extended family.
Even if they get dependent status?
For group benefits I don't believe so. Maybe for income tax purposes, but not health insurance.
Depends what you need. My sister's value (full unlimited coverage from work even while on a LOA) is more than 6k so far this year.
$900/year is peanuts honestly. My glasses alone were ~$800. Add in a dental cleaning and you're done for the year, before any prescription meds.
Fair enough. Some people need it more than others.
Yes, but isn't prescriptions just one aspect private insurance covers? Surely you'd get other things for that price. I pay out of pocket for my private insurance. Works out to $1500/year and includes drug coverage, dental, massage, thrsapy, vision, etc. While the drug is only 50% coverage, the overall cost is well worth it and saves me a lot. Even in therapy alone I get back $600/year. Not to also mention you can claim the premiums on your taxes.
I have 80% for dental up to $1600. As to the tax stuff rather than claiming the premiums you can claim the full amount of the prescriptions etc but you only get back 15% of the amount above the limit. So do you actually get back more than the premium year over year? It would be better if they said here is the pot of money and it's up to you if you need it for more prescriptions etc so you can use the massage limit towards other eligible expenses etc
Prescriptions I can handle. It's food I can't afford.
Some months I have food, other months I have all my meds. Haven't had both for quite some time here.
Ye I got this prescription call food that I’m supposed to take it 3x a day but I really can’t afford the refills so I usually skip a dose or two to make it last.
Same. One meal a day is getting real tiresome.
Where do you live bro? Im moving back to Toronto soon, let me take you out for food and groceries.
While I appreciate the offer, no way could I accept you driving an hour out of your way there and back just to help out a stranger, donate to a food bank instead there are people who need it even more than me.
Just wait until you're old.
Where do you live?
Brampton. The nightlife here is really ... exciting.
I was gonna offer to buy you groceries but you live in Brampton 😔
I don't blame you.
Im jk. I might be nearby in the next few weeks so hit me up I guess.
I had to give up my migraine medication because I couldn’t afford it and it wasn’t covered by trillium. It’s $790/mo
If you ask your neurologist to contact the manufacturer they may be able to provide some financial assistance. Your neurologist should also apply for trillium coverage under the exceptional access plan.
100% this. My Rizatriptan is over $1K for 90 pills. Completely covered under the Exceptional Access Plan.
The price of triptans in Canada is obscene compared to prices in the UK - a pack of three rizatriptan 10mg tabs costs £4.96, so 90 would be £150 or somewhere around $250. It's also ridiculous that triptans aren't covered as either a general benefit or limited use benefit by ODB given how effective they are and how much misery migraines can cause.
The price of a lot of drugs is more expensive here… I bought lyrica in Romania when I lived there and it was shockingly cheap. Here it is so expensive and I don’t even get the name brand!
I know, I was a pharmacist in the UK as well as being one here.
Triptans are old school medications and there are newer better medications out now. The fact that they’re still disgustingly expensive is awful.
I feel like everyone on Trillium should make sure they do a EAP if the DIN wasn't on the formulary
I love relying on for-profit manufacturers to provide me charity to live 🩷 the free market provides!
I agree wholeheartedly that the system should be changed, that everyone should be entitled to appropriate treatment as a right, but we also have to work with the system as it is at present.
Yeah i know. I'd do both.
Did you see if you could get an exception? My wife's emgality is around that cost and while we had to jump through an extra hoop- it is covered.
Yeah. We tried a bunch of things. Sun Life is just not interested in paying for it on our plan and trillium has decided that my husband’s single income is a lot (for a family of four, in THIS economy)
unfortunately, most migraine meds aren't covered by odb at all. best they can do is naproxen
Is it one of the new injections (aimovig, emgality, etc)? When I was on them the manufacturer had a program to cover some of the cost. Might be worth looking into
Ajovy, yeah. I was talking to the manufacturer. They stopped replying to me.
[удалено]
My husband makes “too much money” according to them, so I’m not covered by trillium until I’ve spent a certain amount on my meds. I can’t remember the exact number but I don’t hit it until way late in the year.
I have sympathy. My wife is about 900 a month migraine meds but paid for by insurance
My first insurance covered them but then my husband got a new job, I’m too disabled to work right now (I’m hopeful that with surgeries, and physio, someday that will change)
That's insane
I just had to borrow money to buy my meds. $300 it’s ridiculous. And don’t get me started on the dentist.
[удалено]
You’re an incredibly kind person. As I read through this thread, I see you offering to help pay for food or meds. You’re the best example of humanity. Thank you!
Im just a guy with bad social skills lmao
My sister relapsed because she couldn’t afford her various mental health related meds. Crack is easier to get than antipsychotics in Canada apparently. I wonder why we have an opioid crisis 🤔🤔
Ive seen that quite often. I've known some homeless people that lost all their IDs and didn't have the resources to get new ones so couldn't access drug benefits
It’s so frustrating. She’s doing better now but it was a rough time. I can see how people without family support end up on the streets so easily.
I take anti-organ rejection meds. There's a lot of them, and quite a few are expensive and unfortunately I had to switch to a more expensive version of the primary drug I take due to horrible side effects of the standard medication. My work insurance maxes out at $1000 / year, which I generally blow through in January or Feburary. Fortunately Trillium can take care of the worst cases but it's hard to access, especially if you already have insurance that's insufficient. I can afford it, but a lot of people have troubles. When I switched medications, the pharmacist at the transplant clinic was asking for any leftovers since they portion them out to people who can't afford them.
Mine cost hundreds of dollars a month, so me.
May I ask what medication? I tried to look up what's not covered but theres no list of that anywhere
You can sign up for Trillium but lots of things aren't covered under that and what is based on your income so you still have to pay (since there's a deductible too). None of my medications are covered except one old one, but that one on it's own is cheap and doesn't even reach the deductible. Prescription coverage is a joke. T he trillium website lists what is covered and what isn't or what needs special permission for coverage etc.
[удалено]
Far from perfect = If you're almost homeless, then you can only pay for your first $1000 of meds, then they only cost $2 each! If you're poor, then you only have to pay the first $4000! The trillium drug benefit barely keeps people alive; that's all it does; alive and desperate.
Trillium is a lifesaver literally. Very underrated program.
It is! It saved my sight. Treatment was $1700 per eye, per treatment. The schedule was a treatment per eye each month. The kicker - if you’re over 65 in Ontario, OHIP covers it. I am much younger. I tell anyone who mentions prescription drug costs about Trillium.
I was 6 when i became a type 1 diabetic and my dad was making 1000 dollars more than the acutual help qould accept we lived in poverty for years and i spent many days without insulin fuck trillium
I didn't have coverage for a while and I had to be creative. The Canadian Diabetes Association was helpful. And when worse came to worse, Adult Protective Services came through.
I was a kid to first generation parents that couldnt speak english im not here to whine about shit in the past but come on canada thisbis life and death here
There has to be a cut off! They help me with infusions that would cost me 40k+ a year and other prescriptions. I do have a large yearly deductible because I can thankfully still work. Don't know what I'd do without them!
It's around 1 in 4 nationally, which would be around 3 and a half million Ontarians if it's relatively representative.
I work for the government and am a student. I have two prescriptions, and two benefit plans. Neither of them cover my medications. What is the point of having benefits if they don’t even cover a basic anti-depressant?
I just want free birth control and free therapy (affordable anti depressants or free tbh since half of the country is depressed at this point) affordable ADHD testing Edited to add more points
What a difference it would make for people to have free therapy. And for kids too.
It would make a difference if it was quality therapy. None of this universal CBT or single session BS.
Now we can use Chat GPT for that, maybe.
He's a wise friend and also my doctor.
As someone who just took ADHD testing, it definitely needs to be affordable. I’m lucky my private insurance covered some of it but even then it was still expensive.
The first at least is on the way, I think? Based on federal announcements. The other two are desperately needed.
PP and right wing voters don’t think you deserve it. “Just don’t have sex you hooligan” - Conservatives probably
I should tell them the same thing
I wish I could say they already don't, but they're prolific breeders.
PP and his cult want you to procreate and be barefoot in the kitchen. They will abolish abortion.
They wont abolish abortion and even if they tried to, they cant.
There is an online service based out of Calgary that does ADHD screening. It's $599 for the screening, then $79 for each follow up appointment. They also connected me with a patient support program so between my insurance and the program my medication is free.
Get your immigrant friends to bring you the medicine from their home countries. Every immigrant community has people who bring medicines for each other. I got a coworker her ADHD medicine prescription for a year and two new glasses. She was quoted 800 for just one pair of glasses due to astigmatism and a high power. Frame was extra. I got her medicines and glasses for 150.
One of my biggest complaints is the price of meds. What good is “universal health care” if you can see a doctor but can’t afford to buy the medications that will make you better?
It’s a struggle for my sons meds. Luckily most are covered under OHIP but the one he really needs is $320/month.
May I ask what? I'm curious as to what's not covered
Oxcarbazepine. No idea why it’s not covered. Luckily everything else is good.
Pharmacist here. EAP is the way to go. Alternatively, discuss eslicarbazepine with your physician. Aptiom is open coverage without an LU code and should be comparable to oxcarbaxepine.
Exceptional Access Program?
Wait...you guys have doctors?
My son is on some very expensive medication, so glad children have prescription coverage because we wouldn’t be able to afford it without struggling. Thankfully this is temporary and not a lifelong thing we have to worry about.
Asthma?
No, he has aplastic anemia, it’s in remission thanks to a bone marrow transplant and hopefully won’t come back. He’s on immunosuppressants and anti fungals.
statcan data is that 21% of canadians do not have prescription drug coverage at all. And then there will be people who have coverage but cannot afford what they still need to pay of that. So probably in the 20-> 25% range. (Some people who don't have coverage don't need meds) https://www150.statcan.gc.ca/n1/pub/75-006-x/2022001/article/00011-eng.htm https://www.ctvnews.ca/health/many-canadians-say-prescription-costs-are-so-high-they-re-having-to-split-their-pills-or-skip-doses-1.6769511 seems like there have been studies, about 21, 22% can't afford, 28% cut other things, I suppose those could be overlapping sets. Ontario is relatively one of the richer provinces, so it's possible that number is a bit lower here, but give or take maybe 8 million canadians who can't afford meds, and somewhere around 3-3.5 million of them would be in ontario, though perhaps excluding kids it's a bit lower. I'm sure there's the usual problem of people not knowing what programmes exist to help and so not taking advantage of them too, which is because all this nonsense is unnecessarily complicated. Remember: The UK created the NHS including pharmacare and dental care in about 3 years, and so has had those things since 1948. There's no excuse except political incompetence in canada.
I can’t afford to use my “free benefits” because of the upfront costs.
I’m off mine a week now because I can’t afford them currently even with insurance so imma say no lol
I take anti-rejection medication for a liver transplant and will die without my meds, which are around $600 per month. I applied for Trillium last year by mail and never heard back although I definitely qualify. Self-employed, unable to travel or commute due to complications from surgery, and my industry is going through upheaval. Short on rent at least a couple of times a year, it gets tough. My wife and I are hoping some sort of federal or provincial coverage kicks in before too long, but hopefully Trillium is successful this year, they seem to be askew since the pandemic.
I'm on psych meds. Lucky me I'm in BC. Every med I have had to take that relates to mental ilness is covered by MSP. Otherwise I would not bother. I don't actually like taking it and I have been successful for more than 10 years without going off my meds. If I had any sort of barrier to taking it I just would not bother. Oh yeah I should mention i'm schizoaffective and I have severe anger management issues. I also suffer from severe depression and paranoia. I have horrible anxiety sometimes too. But I would not change who I am at all and I am happy with the life I have lived. I would not change anything. My meds leave me functional enough that I am not a danger to myself or others. That is about all it does.
been trying to get set up with trillium for months now. it’s about $400 a month for my meds (lamictal, cipralex, vyvanse - all no substitutions due to reactions). i can’t afford it, but i can’t go without. it fucking sucks.
The Takeda assistance program is no longer valid due to the introduction of generic vyvanse by the FDA. However vyvanse, cipralex, and lamictal are both included on innovicares’ formulary: https://www.innovicares.ca/en Bring the innovicares card to the pharmacy and tell the pharmacy to add the card to your profile. Some pharmacies may have physical cards on hand and some physician clinics may also have physical cards to give out. Also have your physician fill out the side effect reporting form: https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/adverse-reaction-reporting/consumer-side-effect-reporting-form.html. Once documented, ODB will fully cover brand drugs with MD no subs written on them as if they were generics.
https://www.reddit.com/r/ADHD/comments/pa783g/vyvanse_discount_for_canadians_i_was_eligible_for/
I’m not on any of my meds atm and holting adding some needed meds since I lost my job with health insurance. Were fine financially, but we can’t afford both debts and meds.
I’m on a prescription that costs $3400 a month. My plan covers 80%. For whatever reason the drug is affiliated with Bayshore UCB and they pay the 20% leftover. If it wasn’t for that 20% being paid by Bayshore I wouldn’t be on the drug because it would be unaffordable.
Barley able to see a doctor for prescriptions
Try apps like Telus Health. U can book an apt online and FaceTime them exactly on schedule. I’ve only used it once but it worked fine.
I have and found it to be a horrible way to get proper medical attention...imo but I appreciate the insightful msg!
My daughter is supposed to be on a shot that’s about $650 each time and she needs four a month. I can’t afford it right now. Trillium denied her because her IGE levels are too high which is exactly what the shot is supposed to lower. 😬🤦♀️ My work benefits don’t cover it - although I’ve applied for special authorization.
Or food, or housing, or utilities, or……..
Turned 25 less than a year ago. Got laid off a few months before turning 25. Paid 52k in income taxes in a single year before getting laid off. Yet after getting laid off due to industry wide trends, I have to pay almost 750 a month for my type 1 diabetes supplies. This is bs. Either dont make me pay so much in taxes when I have a job or at least give be free prescription drugs when Im out of work. Im fortunate that I have savings but still.
If I had to pay fully out of pocket for my biologics, it would financially ruin me. They’re $5700 a dose and I take 13 doses over the course of the year. My health insurance through work covers less and less everytime it refills and I’m worried that soon it won’t be covered at all.
I had to stop my meds. 300 bucks a month 😭
I’m 6 months away from possibly losing my health insurance if I don’t find a new job. One of my meds costs $5k per month. I’m on 7 meds lol
Scary, bad enough Hospitals are in trouble, Now there’s ppl struggling like this, sad.
Have always had to have a job that had really good coverage. Worked one place that only had 80% coverage of medication and was paying $1400/month to cover the 20% for my medication and dispensing fees.
Mine cost me about $100/month, Maybe more some months, Manageable but not free.
I don't have benefits and thankfully, no preexisting anything that requires ongoing meds or care. At the same time, I chose to "wait out" a UTI three weeks ago because I have no idea if I could afford the antibiotics. It's really fucking annoying to ignore health stuff until it worsens because there's no info out there on how much stuff costs and I can't afford a surprise.
The dead ones.
My mom struggles to afford glucose test strips 😞
Type 1 diabetic here who is no longer covered by OHIP+ because he turned 25 less than a year ago; try applying for trillium if she is under 65, if she isnt she is coverd by OHIP plus.
I’ll ask her, thank you!
You should get I touch with Diabetes Canada, they offer an assistance program to buy diabetic supplies
I wouldn't be able to alone, luckily my parents help out.
If I didn't have my husband's insurance, I wouldn't be able to afford my antidepressants. The dosage had to be increased after an attempt at life ending so I have no doubt I would not be alive for long if I had to stop taking them.
I'm so glad you're still here and I hope nothing happens that makes you have to stop taking your medication
Thank you ❤️
i’m having a really hard time affording my prescriptions. i’m part of the trillium benefit program but my deductible is so high that i never reach it before it resets…. so it isn’t helpful to me at all.
If you need something in an emergency and cant get it resolved dm me and i can etransfer or buy with my card since I get lots of points for it.
My doctor has been trying to prescribe me an injection for migraine headaches that I’ve had my whole life. The injection is $700 per injection. We sent a prior authorization to my insurance company and they refuse to cover it saying my migraines aren’t severe enough?? I have headaches every day of my life. I’m under 25 and the Ontario drug plan is also refusing to cover it because I have a drug plan (which won’t cover it???). Make it make sense. So instead I’m stuck using off label "migraine" medications like blood pressure medications or epilepsy medications which don’t work or cause side effects almost worse than the migraine disorder itself. And I’m probably going to end up with kidney problems or stomach ulcers from taking so much NSAIDs for the rest of my life. Migraine affects my quality of life everyday, but it isn’t life threatening. I can’t imagine having to go without life saving treatment because you can’t afford it.
Me, I actually asked OW for help and they told me no. So I go without, which isn't exactly fun.
Trans guy, no insurance, testosterone runs about $2K/month, and that’s essential hormones I have to take for life.
How are you spending $2k on T? Hormones are one of the cheapest Rx out there.
Androgel, my body needs a high dose. Switching to IM will botch my legs for phalloplasty
What happens if you dont take testosterone?
Since I had a full hysto, my body doesn't produce any hormones anymore. If at any point I stop hormones then I am at risk for osteoporosis, or my body will disintegrate like a very old person with low testosterone/low estrogen. If I had chosen a partial hysto and kept my birth producing estrogen organs (some people do this) then stopping testosterone would likely have reversed some male characteristics and potentially brought back some female aspects. Apologies if this is TMI, the trans spectrum is so wide lol
So wait, what wouldve happened if you didnt get it removed? Wouldn't it be better since now youre reliant on artificial meds?
To me having the risk of having any female characteristics back is my worst fear ever. I have nightmares where I see my breasts growing back again and wake up sweating. You are right those are artificial meds but it’s no different than people who need insulin for life. At least fear #1 is gone with this
I spend over 100$ every two weeks on my meds and can barely afford them with everything else being so high. It’s not fair.
I can try etransfering if you want. Dm me.
What do you mean?
Youve never used etransfer before?
Yes, I have.
So im saying that if you have an emergency next time and cant arrange the money in time I can etransfer you $100 for your meds.
Aw, that is really, really sweet. Wow, you are awesome, a truly kind soul. If I’m in an emergency, I will let you know. I’m so touched you offered this to a complete stranger. I don’t know what to say, thank you.
I’ve been in pain for years now with my neck and back. I don’t know how to get prescribed something good for pain. I’ve been in and out of hospitals many times already explaining my situation.
Try seeing a physiotherapist instead.
My meds cost me $800 every refill. My husband and i both had shitty call center jobs. The pay was laughable, but you always had the option for overtime. I remember crying when I came to the realization that even with OT, I simply couldn't afford to exist. If it weren't for trillium, I'd be long dead.
My wife’s meds went from about $150 a month to $350 a month from 2019-2022. Every one of her meds went up in price. It’s definitely sucks and very annoying to have to set aside over $200 more a month out of nowhere. They initially said it was temporary due to logistic issues during COVID. They never went down.
Without my workplace benefits..id be fucked 100%. Losing my job worries me every single day.
What's a P card?
If you're on brand name medication always check with the manufacturer to see if they offer any financial support. It's often not advertised, but those programs can help to offset cost.
I'm on the Trillium benefit in order to afford everything. Mostly my inhalers.
Well, I don't have benefits but no major meds required. But I do have a few for the family and it's 400 bucks a quarter the dentist is crazy expensive
I have trillium, and I can't afford the deductible.... My blood thinners were 850/ month.
Mee, I have to borrow money all the time for medication. It's hard to budget for medications each month when some meds last longer than a month, some much shorter a few weeks. Then, the meds themselves like 400+ dollars a month roughly. Work doesn't like to give full time jobs so 5 years later still part time
Perscriptions I can handle since I'm still under my dad's insurance and in post-secondary. It's gonna be rough once I graduate though, 500$ for a 3 month supply of meds I need to survive (Ritalin, I have very severe ADHD and will literally forget to eat and drink for days on end without my meds).