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PostPosted: Thu Dec 14, 2006 4:26 pm 
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Posts: 1054
I came across the term "provincial formulary" on the Twinject Canada FAQ page (it was used in reference to provincial coverage for Twinject) . In Ontario our provincial health plan (OHIP) doesn't normally cover the cost of prescription medication (for the average Joe) so I was intrigued and dug further. Well -- I opened up a really good can of worms.

I discovered the Trillium Drug Program, and it is available to those who live in Ontario and qualify for OHIP. This is not just a program for low income families. It is a provincial insurance plan without insurance premiums. There is no cost to apply or to be accepted into the program. It is for people/families who do not have any private drug insurance or are only partially covered by their private insurance plans. This plan only covers prescription medication but does say it includes "nutritional items" (worth looking into further for the food allergic/celiac). They use the family's annual income and the number of family members to determine a "deductible" that is payed quarterly throughout the year in the form of prescriptions you pay for in full. Once the deductible is paid, all drugs for that quarter are free (I think you pay a $2 fee per prescription). Medications that are covered by the program are in the "Drug Formulary Book" (you can call 1-800-668-9938 to find out which meds are covered or check online using one of the links I've provided below). There is an appeal process called a Section 8 if there is a drug you need that isn't listed. The program starts from August 1st to July 31st and uses your annual income/tax information from the previous year to determine your deductible (you can also check on line to determine what your deductible would be for your family). But when you first apply, you can decide when you want the program to start and they will pay for drugs retroactively if the drugs qualify. So -- it's December now, I have prescription receipts that go back to September, I can request that my "start date" is September, and they will issue a check retroactively (once my deductible has been paid). I really suggest that all of you who live in Ontario and who do not have drug plans (or only partial coverage) go to the links and read more about it -- it can only benefit you. Even for families that don't normally use a lot of meds, with epinephrine and asthma meds, you all know that it adds up quickly (especially if you have more than one child). It's really worth looking into further. I know I'm rambling...but I get excited when I find out about resources like this. I wonder why none of my doctors pointed me to it (knowing we didn't have insurance)? Maybe other provinces have similar benefit plans?

http://www.health.gov.on.ca/english/pub ... llium.html (government site)

http://www.drugcoverage.ca/p_benefit_on.asp (general info site discussing provincial drug coverage across Canada - not a government site)


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PostPosted: Thu Dec 14, 2006 10:04 pm 
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Joined: Tue Mar 22, 2005 6:53 pm
Posts: 1454
Location: Canada
I had never heard of this either---thanks for the info.!


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PostPosted: Sat Dec 30, 2006 11:40 pm 
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Joined: Tue Nov 29, 2005 4:04 pm
Posts: 2044
Location: Gatineau, Quebec
I had heard of the Trillium program, and even know of someone with severe allergies/asthma and a limited income who has benefitted from it - I just didn't know the details. Thanks so much for posting this, ethansmom!

We live in Quebec, and I believe Quebec has a decent public drug insurance plan for those without private insurance. (I haven't had any experience with it because we've always had private insurance through an employer.)

At http://www.ramq.gouv.qc.ca/en/citoyens/ ... blic.shtml it says this:

Quote:
What is the Public Plan?
The Public Prescription Drug Insurance Plan is a government insurance plan offering basic prescription drug coverage. It was set up in 1997 to cover all Quebecers who have no access to private group insurance.

The Public Prescription Drug Insurance Plan is administered by the Régie de l’assurance maladie du Québec.

Ever since the public plan was created, all Quebecers, regardless of their financial situation, have had reasonable and equitable access to the prescription drugs they need.


You can get more info by going to that site and clicking on the other links. I did a quick check and it does cover things like EpiPen, EpiPen Jr., Twinject, Flovent, and Ventolin.

K.

_________________
Karen, proud Mom of
- DS1 (12 yrs): allergic to cashews, pistachios, Brazil nuts, potatoes, some legumes, some fish, pumpkin seeds; OAS
- DS2 (1o yrs): ana. to dairy, eggs, peanuts; asthma


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PostPosted: Tue Mar 20, 2007 8:08 am 
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Joined: Sat Apr 16, 2005 12:09 am
Posts: 1054
Karen it sounds as though Quebec's public plan is more inclusive than Ontario's. I've been meaning to post that I did my own searches using the on-line formulary search tool to see if some allergy/asthma meds were covered under the Trillium Drug Program. Some asthma meds did come up as covered but I was unable to find EpiPen or Twinject. I sent the makers of EpiPen an email to verify and they confirmed that they are not currently registered with the Trillium Drug Program. I found this on the Twinject website under FAQ's:
Quote:
Is Twinject reimbursed by public and private plans?

Update! Twinject is now covered by the provincial formularies in Ontario, Quebec, Saskatchewan and Alberta, as well most private insurance plans. Since Twinject is indicated for use in Canada, it will probably be listed on the remainder of the provincial formularies in the next few months. We will continue to provide updates as the process progresses.

Despite Twinject's website info., when I did my search, Twinject did not come up as being covered. I sent Twinject an email to inquire and when I did not get a response, followed up with a phone call and left a message. This was a while ago, and to date I haven't received a return email or phone call. I was told by the pharmacist and doctor that you could submit a Section 8 appeal through your doctor and the program should cover epinephrine. It does irk me though, that Twinject has this info on their website and it doesn't seem to be the case. Also -- not thrilled that they didn't respond to my queries.


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PostPosted: Sun Jan 06, 2008 10:38 pm 
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Site Admin

Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6476
Location: Ottawa
bump

_________________
Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Tue Mar 31, 2009 9:58 am 
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Site Admin

Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6476
Location: Ottawa
bump

_________________
Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Fri Sep 04, 2009 7:40 pm 
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Site Admin

Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6476
Location: Ottawa
FYI - If you are having a hard time affording your auto-injectors, contact your provincial drug benefit program.

I recently sent an e-mail to the Ontario Ministry of Health:
Quote:
Can you please tell me if epinephrine in the form of an auto-injector (Epipen or Twinject) is covered by the Trillium Drug program for those who are eligible? I don't see either on the Forumulary.

This is a medication that will stop the effects of anaphylaxis (a life threatening allergic reaction). The cost of this medication is over $100.00 per injectable and it is advisable to carry at least two in case of malfunction. Schools require students to carry one on their person as well as to keep one in the office. Daycares are also requesting this so, if a child goes to school and after school care, they may require at the minimum 4. Because it seems to run in families, if one child has severe food allergies, other children are at increased risk of having it as well. This means that they too must have their own auto-injectors as schools and daycares must have the child's name on the label.

In addition to these costs, speciality foods are often required meaning that budgets are already strained. If the parent does not have a drug plan, this can be very expensive. These medications have a shelf life that requires them to be replaced on a yearly basis.

If neither medication is covered, could you tell me how one goes about getting a drug covered?

I am the moderator of a national allergy forum Allergic Living's Talking Allergies. I see from time to time that people are going without as they do not have the means to purchase this life saving medication. This amounts to "Russian Roulette" each time they eat.


this is the response that I recieved today:
Quote:
ODB-eligible recipients can have their costs for certain products used
to treat severe allergy symptoms covered if they are prescribed by a
physician. In order for this product to be covered under the Ontario
Drug Benefit (ODB) program for eligible recipients, physicians must
complete and sign a Special Authorization (Allergen) form (SAA) which
can be obtained by calling 1-888-310-9008.

The patient should then take the completed and signed SAA form, together
with the prescription, to the pharmacy that will then dispense the
product and bill the ODB program. There is no expiration for the
Allergen form and the pharmacy should retain this form in their files
for future dispensing of the product. If the pharmacy has not retained
the SAA form, or if the patient has transferred pharmacies, the patient
will need to obtain a new SAA form from their physician.

The above is the process for obtaining an epipen through Ontario Drug
Programs. If you have any further questions, please feel free to
contact our office.

Murray Morrell
Junior Program Analyst
Drug Payment and Control
Ministry of Health and Long-Term Care
416-326-9885
Fax: 416-327-8912

_________________
Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Wed Sep 09, 2009 9:18 am 
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Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6476
Location: Ottawa
DrugCoverage.ca is dedicated to helping Canadians access reimbursement for prescription medications by providing information on the various types of Private Insurance plans, Provincial/Territorial Drug Benefit Programs and Federal plans available in Canada.

http://www.drugcoverage.ca/default.asp

_________________
Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Fri Mar 12, 2010 2:56 pm 
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Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6476
Location: Ottawa
I am aware that not everyone has access to drug benefits. The cost of an EpiPen/Twinject as well as a MedicAlert bracelet (all of which I consider to be essential) can be off putting. I would hate to think that someone is resistant to use their emergency medicine due to financial constraints.

I came across this information on a local school board site and found the other school board has a similar program. I suspect that most school boards have a similar program. Also, the Trillium Drug Program will assist in the cost of epinephrene for those who qualify. (Epipen/Twinject are not listsed as covered but upon further investigation I have found they will cover it.) http://www.health.gov.on.ca/english/pub ... llium.html

CEFO provides immediate assistance to impoverished children and their families through the Emergency Response Fund. This 24-hour turnaround assistance includes the provision of eyeglasses, EpiPens, medical supplies, food and clothing, transportation, and many other financial needs resulting from family crises.
http://www.catholiceducationfoundationo ... .php?sec=0

Over the past year, the Education Foundation of Ottawa (EFO) provided over $140,000 to pay for winter coats, boots, running shoes, hats and mitts, food vouchers, emergency medication such as Epi-pens and other urgent medications where the family cannot afford it, emergency transportation, and field trip transportation for thousands of low-income students in the Ottawa-Carleton District School Board.
http://www.educationfoundationottawa.ca/

_________________
Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Wed May 04, 2011 5:45 pm 
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Joined: Fri Oct 10, 2008 9:40 pm
Posts: 2034
Location: ottawa
Great find Susan, wonderful that that service is there for those who need it.

Has anyone every submitted their epi case to their benefits plan? I strongly believe a portion should be covered as it is a medical device holder.

_________________
DD 12 yrs -no allergies
4 yr old DS - asthma/eczema Anaphylactic to Peanuts, all tree nuts, sesame , all pea/lentil legumes, gelatin.
Allergic to trees, grass,ragweed, feathers, dander, mold and dust.
Outgrew eggs, fish, shellfish


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PostPosted: Sun Aug 28, 2011 6:57 am 
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Site Admin

Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6476
Location: Ottawa
Quote:
DEY PHARMA
Patient Assistance Program
Patient assistance programs (PAPs) are programs created by drug companies, such as DEY PHARMA, to offer free or low cost drugs to individuals who are unable to pay for their medication. These Programs may also be called indigent drug programs, charitable drug programs or medication assistance programs. Most of the best known and most prescribed drugs can be found in these programs. All of the major drug companies have patient assistance programs, although every company has different eligibility and application requirements.

The DEY PHARMA patient assistance program offers free medication to people who otherwise cannot afford their medications. Patients must meet financial and other program specific criteria to be eligible for assistance.


http://www.rxassist.org/pap-info/compan ... ?CmpId=245

_________________
Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Thu Apr 19, 2012 11:41 am 
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Site Admin

Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6476
Location: Ottawa
In the USA, U.S. National Library of Medicine lists several government programs and nonprofit organizations that may be able to assist.

They also suggest discussing your concerns about paying your medical bills with your health care provider, social worker or the business office of your clinic or hospital.

http://www.nlm.nih.gov/medlineplus/fina ... tance.html

_________________
Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Thu Apr 19, 2012 4:34 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
BC2007 wrote:
Great find Susan, wonderful that that service is there for those who need it.

Has anyone every submitted their epi case to their benefits plan? I strongly believe a portion should be covered as it is a medical device holder.


A bit late to answer, but....

It is not covered by our plan. We do have a very good plan.

_________________
self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings


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PostPosted: Thu Apr 19, 2012 4:39 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
ethansmom wrote:
I came across the term "provincial formulary" on the Twinject Canada FAQ page (it was used in reference to provincial coverage for Twinject) . In Ontario our provincial health plan (OHIP) doesn't normally cover the cost of prescription medication (for the average Joe) so I was intrigued and dug further. Well -- I opened up a really good can of worms.


It's a bit of an overstatement by twinject.

In Ontario Epi-pen IS covered by the formulary. twinject IS NOT covered.

To get it covered, you have to get a letter from your doctor explaining WHY you need that one instead of the one that is covered.

Our policy is through dh's work. Things covered under the provincial formulary are covered at 90%, all others are covered at 50%. It cost me a lot of money to find out the twinjects I purchased were only covered at 50%.

_________________
self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings


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PostPosted: Thu Apr 19, 2012 5:02 pm 
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Joined: Mon Jul 05, 2010 11:37 am
Posts: 1523
Location: Alberta
Now the stuff is hitting the fan.
viewtopic.php?f=48&t=7331

Inteliject???

_________________
Myself - Seasonal, cats
dd-asthma (trigger - flu) anaphylactic to eggs, severe allergies to bugspray and penicilin,pulmicort
ds-Seasonal, cats and OAS
dh-allergy cats, bugspray and guava, outgrew egg allergy


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