Reimbursement Landscape of Medications Coverage in Ontario

Recently I have met with few patients to help them apply for financial assistance of their medications. Just going through the application process with my patients, I find it painstakingly exhausting. I can’t imagine how patients can go through the same process and to cope with their chronic illnesses simultaneously.

In Ontario, people over the age of 65 are automatically covered by the Ontario Drug Benefits Program. They have to pay $100 deductible each year and then $6.11 copay per prescription.  But for individuals who belong to the low income category and many do, they can apply for low copayment program for seniors. Once approved, they only have to pay $2.00 per prescription, to which many pharmacies will choose to waive the copayment.  Unfortunately, not many seniors are aware of this option. Many are not working and struggling to make ends meet. Others just find the system complicated and don’t understand how to navigate it.

And then there is the Trillium Drug Program. I have vented about it in another post. It is so complicated to understand and frankly, not designed to be patient-friendly.  But why are we making it so difficult for patients who apply for financial assistance of their medications.  When I call the program information line for my patients, there are tons of options to select before you get to the right path to hopefully speak to an agent for assistance.  If you choose the wrong one, you have to return to the main menu and need to hear the same damn introduction before you can select the correct option.

After you have spent a good 5 minutes getting through the right option, then you realize that you have to wait in line to speak to a live agent. During the business hours, the line is so busy that you may end up waiting for a good 30 to 45 minutes before you can speak to an agent.

Who has the patience to wait that long when you are healthy, let alone when patients may be unwell?

And then the application form – why are we signing to give consent to Canada Revenue Agency to release information and ask for a notice of assessment from the patient at the same time? Many patients don’t know how to get their notice of assessment and……due to the lack of supportive documents, their application will be put on hold indefinitely! If the government already has this information, why don’t they communicate to each department more, especially if consent has been given?

We have talked about making our health care system more transparent. But I think we also need to make our drug reimbursement system more user friendly.  Take a look at the current reimbursement landscape for medication coverage in Ontario. Isn’t it too confusing?

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But again, I wonder if it is meant to be confusing so not many people can benefit from the programs. Sigh.

 

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drugopinions

My name is Cynthia Leung and I am a practicing pharmacist in Kingston Ontario, Canada. This blog is for me to share my ideas, opinions and perspectives on how medications are used in our health care system. Note that these posts are my own opinions and do not represent the opinions of my current or former employers and / or organizations that I may belong to. Any possible case scenarios described in my posts would be modified to maintain patient confidentiality. This blog is not a platform for professional advise for patients or health care providers and the content is not meant to support any clinical decisions or replace professional opinions. Also the images are either taken or created by the author, or adapted with permission. I hope you will enjoy reading my posts!

2 thoughts on “Reimbursement Landscape of Medications Coverage in Ontario”

  1. I have had a patient that required similar forms, and he was illiterate so it fell to me to fill our his forms to take to the physician to sign (his office wouldn’t or didn’t fill out the forms for him) every three to six months depending on the medication. I feel for you and your patients; it is a necessary evil to get the medications approved that these patients need. But you are a compassionate pharmacist so I know you put up with the hassles of long phone waits, etc. Good luck serving your patients. ~nan

    Liked by 2 people

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