[Keely]

Does anyone know if Health Canada is paying for Tysabri yet?

I read on MS Canada that this was being considered, and that an announcement would be made sometime this month. Just wondering if it was going to be covered on Canada's national health care plan, or if it will continue to be covered only by private insurance, like it is here in the U.S.

Does anyone out there know?????

[tovaxin_lab_rat]

Originally Posted by Keely

Does anyone know if Health Canada is paying for Tysabri yet?

I read on MS Canada that this was being considered, and that an announcement would be made sometime this month. Just wondering if it was going to be covered on Canada's national health care plan, or if it will continue to be covered only by private insurance, like it is here in the U.S.

Does anyone out there know?????

Here's a link to the NMSS in Canada. This might help answer your questions...

http://www.mssociety.ca/en/research/...aq_tysabri.htm

One question is:

Q. Will my insurance cover the cost of Tysabri?

A. According to Biogen Idec Canada, most private insurers are now reimbursing the cost of Tysabri. Generally insurance companies require prior authorization before they will reimburse. This means that the insured person needs to contact his/her insurance company in advance of purchasing the drug to ensure that the cost will be reimbursed.

[Harry Z]

Originally Posted by Keely

Does anyone know if Health Canada is paying for Tysabri yet?

I read on MS Canada that this was being considered, and that an announcement would be made sometime this month. Just wondering if it was going to be covered on Canada's national health care plan, or if it will continue to be covered only by private insurance, like it is here in the U.S.

Does anyone out there know?????

Keely,

I think the decision to cover the cost of Tysabri infusions lies with each Province's Health Ministry. Since each Province controls their own health system, they have the final say. I would therefore contact your Provinical Health office and ask the question there. Please let us know what kind of answer you get.

Or course, if you carry private extended health care insurance, you should explore that avenue as well.

Harry

[Keely]

Thanks for the info, Harry and Cheryl!

Actually, I live in Colorado and I'm an American...I was just curious!

It seemed interesting to me to find out how they would handle an expensive drug therapy like this on the Health Canada system...

If I find out, I'll post the info here!

[lady_express_44]

I'm not sure if it is an approved expense for those who are only on their provincial health care plan, but last I heard it wasn't yet. It is an approved drug option here, but isn't "free" to the best of my knowledge. Our drugs are often a lot cheaper up here though . . . even if we have to pay out of pocket.

Most people in Canada who were working when they went on disability, or who continue to work, have very inexpensive extended health care coverage. The monthly premiums for that benefit, which is quite often paid by our employers (or ex-employers), amount to about $20 a month, with very few co-pays on anything we might need medically.

From what I understand, the TOUCH program is only mandatory in the USA, and I'm guessing the Canadian government will be waiting their "standard 2 yrs" before they decide whether to get in the game with taking responsibility for this drug. I was surprised when it was approved so quickly after the US . . . but am not surprised that the Canadian government is stalling on "endorsing" it's use by paying for it.

(They also don't like getting sued or blamed for allowing people to get sicker . . . if that's what had ended up happening with the reintroduction . . . so they might be biding their time in this regard too).

BTW, I was wondering . . . don't most people down there have a max-lifetime cost for medications/expenses with their private carriers? If this drug is as high as $100,000 a year, it won't take long to use up their lifetime allowance on this one treatment . . .? (We have lifetime max's on our insurance . . . that's what made me think of it).

Cherie

[Harry Z]

Hi Cherie,

You are right in stating that private extended health care insurance in Canada has a maximum life time benefit amount. This is usually determined by the level of policy that you have based on the premium you pay. But a decent plan that would cover medical and dental expenses would cost a lot more than $ 20.00 a month. I, under single coverage, pay $ 150.00 a month. A family would obviously pay more.

I'll make a few phone calls on Monday and find out about Tysabri coverage in Ontario. With health care costs skyrocketing, the government here is quite slow to approve expensive drugs like Tysabri. They always look at cost vs benefit. I'll get back to the forum when I get an answer.

Harry

[lady_express_44]

Originally Posted by Harry Z

Hi Cherie,

You are right in stating that private extended health care insurance in Canada has a maximum life time benefit amount. This is usually determined by the level of policy that you have based on the premium you pay. But a decent plan that would cover medical and dental expenses would cost a lot more than $ 20.00 a month. I, under single coverage, pay $ 150.00 a month. A family would obviously pay more.

Do you pay for a private plan, Harry? Is it a retirement plan?

I get mine paid for by my (ex) employer, because I am on LTD (permanent). I was the HR manager for the company and maintained all the budgets for these employer costs.

It may have been that we got the premium for much less then some other companies, because of the size and demographics of the organization, but it was less then $20.00. I retired on disability in 2005, but I doubt it's changed much (at least for that size firm) since then.

Does your provincial health care plan pick up on excess over the limits; annual and lifetime?

Cherie

[Harry Z]

Originally Posted by lady_express_44

Do you pay for a private plan, Harry? Is it a retirement plan?

Yes, I pay for a private plan which I recently updated and improved my coverage.

When Marg was forced to go on LTD and then retirement because of her MS, the extended health and dental coverage she had with her nursing job (employer paid for some of it which resulted in low monthly premiums) she was able to retain the most basic plan without having to complete a medical questionnaire or have a medical check-up. To continue with the same plan that we enjoyed while she worked would have been impossible because the MS would have excluded her for most of the benefits as it would have been a pre-existing condition. The plan that we were allowed to keep was the most basic one and its coverage was really low.

Does your provincial health care plan pick up on excess over the limits; annual and lifetime?

It works the other way around. The Provincial Plan covers most of your health care costs and there are no limits. It doesn't cover rx drugs (except for seniors and/or some treatments) dental care, chiropractic, psychologists, optometrists and a few other services. People usually get the extended coverage plans which vary in cost and coverage. For instance, the Provincial Plan covers hospital ward bed costs but not semi or private rooms. Your Extended covers most if not all of the difference.

Harry

[lady_express_44]

Originally Posted by Harry Z

It works the other way around. The Provincial Plan covers most of your health care costs and there are no limits. It doesn't cover rx drugs (except for seniors and/or some treatments) dental care, chiropractic, psychologists, optometrists and a few other services. People usually get the extended coverage plans which vary in cost and coverage. For instance, the Provincial Plan covers hospital ward bed costs but not semi or private rooms. Your Extended covers most if not all of the difference.

Harry

Yeah, it works the same way here . . . but I was thinking strictly about the cost of prescriptions.

They implemented this new plan here a few years ago, whereby the government picks up on some amount of the rx's, even if you have an extended health plan (which most of us do, if we are employed, on LTD, or private plans, like yours). You HAVE to register for it (it is something beyond standard medical or low income prescription coverage), and they top up on some amount of rx's. I haven't made use of it in any way because I hardly use medication, so I'm not even sure how it works . . .

That's what I was asking if you knew anything about . . .?

Cherie

[Harry Z]

Cherie,

There is a drug plan in Ontario called Trillium. It is designed to pay for normally very expensive drug treatments and that is what Biogen is trying to get the Provincial Health people to approve. I'm not sure just where Tysabri stands at the moment but I will attempt to call the MS Clinic here in London tomorrow and see if they can tell me anything. Will get back to you with an answer.

Beyond that plan, prescription drugs (except for seniors) are paid for by the individual who then claims the cost through their private plan, if they have one.

Harry