Remicade costs in Ontario

Hoping to get some information on Remicade costs, and how the payment and coverage works. My insurance plan will cover 80% of medication costs. That would likely leave a significant amount for me to cover for my 19yr. old Daughter.

Does anyone have any information regarding this? I came accross an American site that explained abit about Remistart, and then another supplemental programme, but nothing for Canada.

Tom,

Thanks for the link, but that was the website I was referring to. It seems to be only for residents of the U.S.

Is there a Canadian equivelent?

Tom.

Hey Monte - Because I was self employed and just starting out when I came down with this disease, I had no drug/benefits plan at all - in fact now I can't get one because of my illness without paying a small fortune - I had to use (and still do) Trillium Drug Coverage - the Ontario Drug Plan. So the coverage (or deductible) is based on income level. For me, my deductible or out-of-pocket cost ranged around was $300 every eight weeks when I first started. Trillium requires a doctors letter explaining that you have to have this drug (remicade) as there are no alternatives for your (or your daughters) situation... So it's a bit of a process. But your GI will take care of this. They may have special case extended coverage that you can add on to your current plan.

The absolute best thing to do is simply call your GI's office tomorrow. They will tell you exactly what your options are and how to get further or extended coverage if you need it. There is something: similar to what you read about in the US with Remistart. I forget the name of it off the top of my head, but there is in fact a program as it was mentioned to me. The actual remicade nurse (not so much the GI's nurse) will know all about it if you are at the point where you have talked to them. I think it will be the same person as I had.

If you email me I'll give you her name - I had her number as well, but I deleted it after I stopped. But at least with her name you can ask the GI for her contact number, they will most definitely have it on file - and she'll explain your options.

Anyway the GI's office does it everyday and they will organize everything for you, get you in touch with the right people etc.

FYI - My typical infusion cost roughly $3,400. So with 80% coverage your looking at $680 every eight weeks if I did the math correctly. I hit that range on the second year due to a wage increase - it hurt...

Hope this helps,

Mark

Unfortunately I don't think remistart is available in Canada - it's basically trillium and that's it in Ontario. From what I understand remi is fully covered in other provinces.

Tom,
Trillium?
Read this it is older but any how might be of interest.

https://www.healingwell.com/community/default.aspx?f=38&m=986416

Tom

Update:

I did get in touch with a co-ordinator today. She (co-ordinates) between the GI, the infusion center, the drug company, and handles the paperwork for insurance, and any additonal financial assistance.

The good news is, that whatever portion my insurance won't cover, there's an extended plan to pay for the balance.

So right now it looks like there will only be a minimal cost to me each month.

Rough numbers being, I would have had to pay about $400-$500 a month without this, so it's really significant.

Thanks to everyone for replying.

Tom.

Oregon US cost of one Remicade infusion $10,670. At present Blue Shield is allowing about $7000. Why on earth is it so expensive?, I have no idea.

Thanks Tom,

I'll be sure to ask abut that when things get started.

Tom.