As we continue to hear how Canada should develop a National Pharmacare Program – at least with essential medicines, I can’t help but feel that we need to first fix our Trillium Drug Program.  In Ontario, individuals who require financial assistance for their medications can apply for the Trillium Drug Program. It will qualify everyone who applies, just that the deductible will tailor to the individual household net income.

While the program can help with many individuals struggling financially to pay for their medications, it is administered in a way that is too complicated for most people to understand. Many also don’t have the patience to follow through.  Was it designed with the patients in mind, or was it designed to ensure there is minimal uptake to curtail the program expenses?

The program is set up with the annual benefit year from Aug 1 to Jul 31. The annual deductible is however based on the net income from the previous year. If there are sudden financial changes which happen a lot to patients with chronic diseases (e.g. no longer able to work, need of expensive therapies), the program is not set up automatically to capture this event. You have to personally request a reassessment, in hope that the annual deductible will be reduced.

For the program to work perfectly well, you have to submit the application at least two months before the benefit year begins. If you have missed this deadline, you will then have to pay in advance to submit your receipts afterward.

Below are few of other highlights of the program that boggle my mind:

  • If the annual deductible is to be paid quarterly, why not list it as a quarterly amount in the program manual? We are expecting the patients a lot by asking them to go through those complicated excel tables to figure out which deductible amount they have to pay – then figuring out on a quarterly basis, how much they have to pay out of pocket before the program will kick in to cover the medications?

 

  • Many patients who require the Trillium Drug Program are struggling in their lives – they don’t always have it altogether to do their income tax. Hence the minimum requirement to provide the notice of assessment as proof of net income is difficult to meet.  There must be another easy way to provide as proof of low income.

 

  • Many private insurance companies have moved to self submission of prescription claims, instead of the archiac process to mail in the receipts for reimbursement. Not only is this process time consuming, it isn’t environmentally friendly. Why can’t the Trillium Drug Program invent something more innovative too?

 

  • Patients usually don’t wake up one day to realize that they have new chronic conditions and that they will be requiring expensive medications to manage their health. It takes time to accept the new condition or diagnosis and realize they require assistance. Our system should be more forward thinking to proactively help them with financial assistance.  How about implementing a mandatory monthly contribution from the individual savings to a wellness account that can be used toward healthcare expenses in time of need?

As much as I do not like how the Trillium Drug Program is being administered, it is still the necessary evil for individuals who require financial assistance with their medications. I hope the Ontario Drug Benefits Program will revamp this program soon to make it truly helpful for patients.

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