treatment not covered , now what???

Question

we are only able to finsh to week 24 and then fair pharmacare wants us to pay 10000$ deductable , we are no where near able to pay this as hubby is on medical leave from work and even if he wasnt we are still a family of 6 on 1 income , not sure what to do as hubby is und and has been since week 12 , what is the likely hood of it not coming back now if he were to stop treatment ?? do we have other options other than paying the 10 grand , can we wait for new treatments to come out that may be cheaper , HELLLLPPPP??

sanman60 · Answer

olivia68 ,
 Contact Gileads Patient connect group.  you can get Sovaldi to $5 a scrip,  Might take some patience, but can be done.  Same with Bristol Myers Daklinza.

flyinlynn · Answer

Hi 

you have added a comment to a thread from 2010 if you would like to ask a new question I suggest you go to the top of the page and select the "post a question" link

Best to you

mannfrau · Answer

b.c.,canada keeps removing prescription items from their list and leaves you if you can to cough up the $.

GoofyDad · Answer

What genotype does he have? The GT influences treatment duration protocols.

Trish77 · Answer

Olivia,

I think the numbers are different for persons in Canada.  This is a link to the December HepC.Bull newsletter:

http://www.hepcbc.ca/bulletin/2009/2009-12.pdf

If you scroll through it to page 7, it contains information for the contact numbers for the helplines for both Pegatron or Pegasys, whichever your husband is currently on.

The hepcbc.ca website is one of the best resources in Canada for persons with Hep C and if you aren't aware of it already, I'd give it read.

Beyond that, you can also look into coverage through your provincial drug plan - your pharmacist might be able to help you with the forms for that and your physician also.  It takes awhile to process the paperwork and there is usually a deductible and coverage is based on income.

Between those things, I hope that works out for you and your husband.

Trish

Trish77 · Answer

Prescription drugs in general are covered. I was denied coverage for drugs under the Ontario drug plan Trillium - not social assistance - because I was at Stage 1, Grade 1. In Ontario, they will often deny coverage for early stage treatment, a position that bothers me immensely. My first hepatologist appealed and they denied him a second time and it angered him mightily. My next treatment team out of a major centre in Toronto were prepared to fight for it and felt they could win but they still would have had to fight for it. Ending up on a clinical trial put a stop to all that. I would imagine that being on welfare has no bearing on approval but rather whether the treatment in general is approved. Once on treatment, rescue drugs are covered and subject to the same criteria - use your work benefits first, then Trillium for whatever the work benefits don't cover, subject to a deductible and variable coverage based on income and IF the government approves those drugs for coverage - eprex/procrit was covered as was the neupogen.

Rockerforlife · Answer

Does welfare for the hepatitis TX ?...and the rescue drugs?..in canada?

Trish77 · Answer

"Your profile seems to indicate BC.  Doesn't the Canada government cover treatment and health costs? "

Prescription drugs aren't covered under universal health care in Canada.  Medical treatment and tests, yes.  Not prescription drugs.  There are provincial drug plans in each province that you can apply to that will cover some of the costs of drugs based on income and if you qualify.  You pay a deductible you have to spend your deductible amount first and then the coverage kicks in.  The only way all your drugs get covered is if you're on social assistance.  The plans differ also from province to province, this isn't a federal plan.  The federal government gives monies to the provinces for healthcare and the provincial governments manage the healthcare for their respective provinces.

Rockerforlife · Answer

Hres a facebook page discussing ur same delimma,it may be helpful




http://www.facebook.com/topic.php?uid=2242426368&topic=2951

Rockerforlife · Answer

Im not sure how the health systm workd in BC canada as they have different policies in the 10 "states"..er..provinces.

jdwithhcv · Answer

I'm not sure that I understand you.  Is your husband on week 24 of tx and now the insurer wants a large copay or is he on week 6 and the insurance says they will only pay for 24 weeks?  Also, what is his genotype?  Does his doctor have any authority in this matter?  

If he is only on week 6 at least you have lots of time to figure out what to do.  Try calling the Schering Plough number posted above and see if they will give you any help.  Contact your insurance carrier and get a complete understanding of their decision, and why it was taken.  Ask the doctor to intervene.  Start saving money, any way you can.  Most important is that you don't panic and don't give up.

Not sure how they work these things out in Canada but her ein the US, my insurance demanded proof that I was responding to the treatment to continue paying for the drugs past 24 weeks.  

Good luck.

olivia68 · Answer

not sure what happened but when we were going to renew our pharmacare, to pay the deductable they said his deductable would be 10,000, not sure ?? how they want us to cover this , they had threatened no to cover after he was inton week 6 as for the drug it is pegetron/ribvarin combo 1 shot weekly 7 tabs a day,[maximum dose]

FlGuy · Answer

Your profile seems to indicate BC.  Doesn't the Canada government cover treatment and health costs?

Rockerforlife · Answer

Ontario Drug Benefit: Trillium Drug Program
The Trillium Drug Program is available to all residents of Ontario with valid Ontario Health Insurance (OHIP) regardless of their income level. Individuals or families can apply to the Trillium Drug Program if private insurance does not cover 100% of their prescription drug costs and if they are not eligible for drug coverage under the ODB Program. The program has a deductible that is based on income and family size. 

http://www.drugcoverage.ca/p_benefit_on.asp

Rockerforlife · Answer

If u are in Ontario,Canada,there is a drug program called Trillium that will pay ur copay.Not sure where u are.

nygirl7 · Answer

Oh good glad WID had the numbers for you!

nygirl7 · Answer

Try calling the drug companies.  When my insurance denied my extension to 72 weeks they picked up the extra six months for free. They might have something that can help you with this exorbitant cost perhaps.

Pegassist for Pegasys - Commitment to Care for PegIntron

And they gave me the riba for free. Sorry I don't have the numbers any longer but I know you can google them that is how I found them when I needed it!

WriteItDown · Answer

Both Roche and Schering-Plough have assistance programs.  You should definitely not stop the tx if it is working! Call and ask for their patient assistance programs:

Pegassist (Roche Pegasys system): 1-877-734-2797  (if he's on Pegasys)

Commitment to Care (Schering- Plough PEG-Intron system): 1-800-521-7157  (if he's on Pegintron)

GOOD LUCK!