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Medicine Coverage and seeking a 2nd opinion!

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Ulcerative Colitis
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Posted 5/3/2018 8:30 PM (GMT 0)
Dear Community,

I am coming up on my 1st year of having UC. The doctor diagnosed moderate colitis and prescribed me a steroid(never took it), mezavant and salofalk (suppository). I have been taking the mezavant and salofalk and have had two clear CRP and other blood work tests since. I have had zero blood in my stools (one of my symptoms) and very little stomach pain another one of my symptoms. I now have a colonoscopy scheduled for May 16th to have a look inside.

I have two problems I am currently facing. One the last time I meet with with my GI I he was kind of arrogant and despite the great blood work results did not believe I could reach remission without steroid or biological. He's been pushing them since the get go. I want to seek a 2nd opinion but not sure how to do it in Canada as you are kind of just referred to whoever the GP says. So how do I get a 2nd opinion from a different specialist? My GP told me I am stuck with my GI until he retires, my GP is kind of a tool too but easy to get into.

The second problem is my work is looking at reducing our drug coverage to a maximum of $5000 or $3000 a year. I think this will cover my mezavant and salofalk but if I am pushed to use a biological I hear they are $40,0000.00 a year. If my plan only covers a measly amount what am I to do with the rest of the cost? Do I pay out of a pocket and then can write it off? Does my province cover the rest? Do I get it back on my taxes? Or am I hooped?
Posted 5/3/2018 9:49 PM (GMT 0)
Your GP is definitely a tool. The first time I met my GI I didn't like her and my GP offered to refer me to another one but I decided to try again and ... I don't know if she changed or I changed but I actually like her a lot now. But the moral of that story is that my GP was more than happy to refer me to someone else. If you don't want to (or can't) try a new GP then one suggestion is to go to a walk-in clinic and get a referral --- but be careful. Some GPs would drop you as a patient for that, and if your guy is as much of a tool as you say then that just might happen.

As for how to pay for the biological if your work benefits won't cover it, I am not too sure what to do about that. Some of them (like Remicade) apparently have programs to help with the costs if the patient can't afford them. The province does not pay for drugs except for those administered during a hospital stay - UNLESS you are below a certain income level then you can apply for whatever program your province has to cover/subsidize your prescription costs. As for taxes, there is a Medical Expense Tax Credit. I don't know many detail of how it works, but you could look into it easily enough. Here is a blurb I found just from a quick google search:

The medical expense tax credit is a non-refundable tax credit that you can use to reduce the tax that you paid or may have to pay. If you paid for healthcare expenses, you may be able to claim them as eligible medical expenses on your income tax and benefit return.
Posted 5/3/2018 9:58 PM (GMT 0)
I agree with Serenity, if you don't like your GI, see someone else. It's good that you've gotten stabilized without prednisone, and that your blood work looks good. Is this GI the same person who will be doing your scope? I think I'd be a nervous having someone do my scope if they are pushy about drugs. Ultimately, it is your decision, they can make suggestions but if you are doing well, you can say no. It does seem like jumping the gun to go on biologics if you've only had UC for a year, and your symptoms are managed with mezavant and salofalk. I guess the scope will tell the story. If it shows remission, then you won't have to worry about the cost of the biologics, at least not for a while. I don't know about the drugs in CA, but here in the US you can get on a program through the manufacturer to reduce the cost a ton. Sometimes down to $5. Also, these ridiculous priced infusions you may read about here, are largely costly because of the facility expense. Here in the US, that expense is billed as medical, not RX. Then the cost of the drug, you can use the manufacturer program to reduce. You could also opt for something like 6mp/imuran if needed, those are much less expensive.
Posted 5/3/2018 10:00 PM (GMT 0)
I think I am going to try and find a different GP that statement blew me away. What's the progression of medicine for our disease? Is Remicade the last resort before surgery? Also I noticed on your write up, you have reduced your Mezavant, I didn't know that was a possibility if things are going well. I am hoping my scope is all good, as I feel fine.
Posted 5/3/2018 11:01 PM (GMT 0)
I think I've read iPoop describe two different approaches that GI's use in regards to meds. A "bottom up" approach which means to use the lowest level meds (such as mesalamine) and progress up the med "ladder" with the biologics being near or at the top of that ladder. And then there are GI's who prefer to go straight to the big guns which it kind of sounds like your GI wants to do. I only know this from reading on this forum, I have only had experience with mesalamines myself.

As for your second question, yes it is common to be on a higher dosage of meds while there is active inflammation and then go down to what's called a "maintenance" dosage when you are in remission.
Posted 5/3/2018 11:32 PM (GMT 0)
Hello and welcome to a fellow Canadian (go Jetts and Raptors!)

I have some medical coverage but all my biologics (4 ) have been covered by the pharmaceutical company without fail. Companies realize that unless you have unlimited resources these drugs are unaffordable.
Posted 5/4/2018 4:00 PM (GMT 0)
Great. Thanks everyone!
Posted 5/4/2018 5:48 PM (GMT 0)
Try not to gloss with one statement about Canadian health, medical process. Every province is different as is every doctor and referrals.

Tell your GP to send you to another GI. Waiting is a long while possibly. Do YOUR research and request for a second opinion.

www.ratemds.com

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