Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
I signed up for fair pharamacare after I started taking the more expensive Arava over the MTX. I didn't however sign up for the monthly payment plan like an idiot.
When I started taking the Enbrel the first time around I was already past my yearly deductible (I think is $800 - based on your income) and kinda forgot that it resets every January. Last year I got caught having to pay the whole deductible at once in Jan becuase it takes up to 6 weeks to sign up for the monthly plan.
You have to wait until Sept 30 to sign up for the next year (so they have your income information). I forgot and didn't phone until the beginning of December. It was supposed to take 10 business day or less to get the form - fill it out - send it back (4days) - then process it (3 weeks) - SO I thought I still had given it enough time. I didn't need to fill my Enbrel until mid Jan.
WELL... it took more than 12 business days to get the form. Not sure exactly when it arrived as I had left town on Christmas vacation (delayed things 10 days).
-I was able to fill out the form and send it back on Jan 3.
-I called them on Jan 20 to see it was done... they have no reccord of receiving my form?! Could mean its still sitting on someones desk waiting to be processed but they have no way of telling me if its lost or in the building.
-Offered to mail me another form.... MAIL ME... Uhhh didn't I just tell him that I need to fill my script as soon as possible I've already spaced out two shots and I'm about to miss another entirely.
-Then he offers to FAX me the form!!!! - Why the #%$*!@#$ didn't they just do that to start with or at least tell me it was an option.
-I filled it out and promplty send it back snail mail.
-I was forced to fill my perscription today (RA is Flaring badly) and it turns out that they have now processed it. Not sure if they got the original or the new form - but its on the payment plan now.
BUT... get this, I negectled to read the fine print. The payment of $67 - 75 per month is for the first part of the yearly deductible only. They cover only 70% until you reeach the max which is usually $300 above your base deduuctible. The Enbrel is over $1,500 for one month so my portion of the 30% is gonna be $275 - plus my monthly payment of $75 that I will pay seperately to the government. Next time I renew it will be free (over the yearly max).
OKAY that's still better than paying the $800 or 900 upfront but not as cheap and I had budgeted for.... why wouldn't they just put the whole yearly deductible 70% and 100% on the payment plan?! ITS SO DUMB!
My advice to anyone in Canada with RA is sign up for Fair Pharmacare with the monthly payment NOW even before you need it to avoid delays in coverage. ALSO if your first prescription refill of the year is a biologic be prepared to pay 30% of the cost after your deductible!
When I started taking the Enbrel the first time around I was already past my yearly deductible (I think is $800 - based on your income) and kinda forgot that it resets every January. Last year I got caught having to pay the whole deductible at once in Jan becuase it takes up to 6 weeks to sign up for the monthly plan.
You have to wait until Sept 30 to sign up for the next year (so they have your income information). I forgot and didn't phone until the beginning of December. It was supposed to take 10 business day or less to get the form - fill it out - send it back (4days) - then process it (3 weeks) - SO I thought I still had given it enough time. I didn't need to fill my Enbrel until mid Jan.
WELL... it took more than 12 business days to get the form. Not sure exactly when it arrived as I had left town on Christmas vacation (delayed things 10 days).
-I was able to fill out the form and send it back on Jan 3.
-I called them on Jan 20 to see it was done... they have no reccord of receiving my form?! Could mean its still sitting on someones desk waiting to be processed but they have no way of telling me if its lost or in the building.
-Offered to mail me another form.... MAIL ME... Uhhh didn't I just tell him that I need to fill my script as soon as possible I've already spaced out two shots and I'm about to miss another entirely.
-Then he offers to FAX me the form!!!! - Why the #%$*!@#$ didn't they just do that to start with or at least tell me it was an option.
-I filled it out and promplty send it back snail mail.
-I was forced to fill my perscription today (RA is Flaring badly) and it turns out that they have now processed it. Not sure if they got the original or the new form - but its on the payment plan now.
BUT... get this, I negectled to read the fine print. The payment of $67 - 75 per month is for the first part of the yearly deductible only. They cover only 70% until you reeach the max which is usually $300 above your base deduuctible. The Enbrel is over $1,500 for one month so my portion of the 30% is gonna be $275 - plus my monthly payment of $75 that I will pay seperately to the government. Next time I renew it will be free (over the yearly max).
OKAY that's still better than paying the $800 or 900 upfront but not as cheap and I had budgeted for.... why wouldn't they just put the whole yearly deductible 70% and 100% on the payment plan?! ITS SO DUMB!
My advice to anyone in Canada with RA is sign up for Fair Pharmacare with the monthly payment NOW even before you need it to avoid delays in coverage. ALSO if your first prescription refill of the year is a biologic be prepared to pay 30% of the cost after your deductible!
I think because health care is a provincial jurisdiction, each province has their own plan. My sister has MS in Ontario and she cannot be covered, because she was not on the plan prior to her diagnosis. Shades of American health care.
Unless I am mistaken, BC is also the only province less that charges a monthly premium for BCHCP. Even in Alberta it is now free.
Hope the Enbrel helps straight away & makes things better.
It is always interesting to read on DS the different experiences that we share about our access to Drs, Specialists & the drugs that we so desperately need. I still find it hard to understand why the process accessing drugs is pathed with stress, heartache & difficulty when I believe all sick people should be able to access drugs easily.
I was on Enbrel in 2009 after failing about 4 other drugs and my Rheumy completed the paperwork & sent it away to Australian Health Department for approval. I received in the mail a prescription for Enbrel & filled it that day. 4 Enbrel injections cost me $32.00, that is $8 each. On the Enbrel box it showed that the real cost was $1,500 and that was the cost to the government. There was no stress for me & if I was a pensioner or on disability, I would've got 4 Enbrel injections for $5.
Australia has a PBS scheme (Pharmaceutical Benefits Scheme) that is subsidised by our government (i.e. taxpayers). The PBS Board decides which drugs to subsidise according to the benefit for the patients & negotiates prices with the drug companies. I have never experienced any stress about not being able to afford the med's that I need & cannot understand why other western countries don't support their chronically ill. It often leaves me feeling so sad to hear the cries of people on this site who cannot access the med's that they need.
Unfortunately, Enbrel wasn't the right drug for me but I can afford what I need. I realise that I am lucky to access the medical care here that I need, but I don't think that should be a privilege in a western country, but a basic right.
Cheers, Anna
H
Our basic health coverage is somewhat mandatory... you can't even see a GP unless you want to pay out-of-pocket for it. I've been on the BC plan I switched from my parents plan at 18. The basic plan has absoutely no drug coverage.
If you don't sign up for the fair pharmacare or make too much money you get no help with drug costs. I was able to sign-up after I was diagnosed though.... I find that a bit shocking (Ontraio won't cover her). How can a pre-existing condition be turned down by government health care? My Rhuemy had to fill out paperwork for a "Special Authority" before I could get coverage - but that was no problem - my rhuemy fibbed a bit on the form - he said I was sero-positive - I'm not. He was convinced I had RA and wasn't gonna let them slide out of paying. They have changed the criteria now - it doesn't matter anymore.
In BC pharamacre is run by the government and provided you meet thier criteria for the disease, age, income - you are covered.
She must not meet one of the disease criterias they have established for MS... in otherwords her doctors can't get her special authority approved. MS is one of those conditions there's no blood tests for ETC. Makes it hard to define.
Anna - don't get me wrong I do have coverage... its just complicated and ill managed. Dealing with the government can be frustrating - the gov't machine doesn't seem to have much common sense. It sounds like your experience was much more pleasent than mine.
Thank you for both of your comments.