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> asking insurers to distinguish this case It's a strange idea to me. Public insurance in Ontario, Canada makes coverage decisions at a high level, such as wh
by retrac 4y ago
> asking insurers to distinguish this case
It's a strange idea to me. Public insurance in Ontario, Canada makes coverage decisions at a high level, such as whether a drug or procedure will be insured. If it's covered, physicians make the decision. Some medications are restricted to specialists (only infectious disease experts can prescribe HIV antvirals and have it covered, for example). And some are limited use, i.e. for specific indications the physician needs to tick off.
Neither fraud detection nor abnormal prescribing need the power to review and potentially deny individual prescriptions. If a particular doctor is prescribing all weird and not to typical norms, that can be addressed directly.
- twoodfin 4y agoNeither Entyvio nor Remicade show up in a cursory search of the Ontario-approved formulary[1]. Where does that leave this desperate patient if he lived in Ontario? Should his Canadian doctor be able to prescribe these drugs for Ontario to pay for regardless? Many ITT seem to think this is obviously true. [1] https://www.formulary.health.gov.on.ca/formulary/ https://www.formulary.health.gov.on.ca/formulary/
- junofan 4y agoThey do forced switching up north AFAIK.
- retrac 4y agoDrugs admistered in hospital are handled separately. A brief search suggests generic infliximab is covered: > Effective December 18, 2020, Avsola (infliximab) will be added to the Ontario Drug Benefit (ODB) Formulary as a Limited Use (LU) benefit for the treatment of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), plaque psoriasis (PsO), ulcerative colitis (UC), and Crohn’s Disease (CD). Drug brand names are often different here, which is confusing. If it is not covered publicly, you need private insurance, or to pay for it yourself.
- ceejayoz 4y agoRemicade has a generic: https://www.formulary.health.gov.on.ca/formulary/results.xhtml?q=Infliximab&type=1 https://www.formulary.health.gov.on.ca/formulary/results.xht...
- twoodfin 4y agoI’m curious if the treatment this patient received would be considered off-label in Ontario. That’s really the issue here. If it were on-label in the US, I’d be taking a very different angle on this!
- torstenvl 4y ago> only infectious disease experts can prescribe HIV antvirals and have it covered, for example Jesus fuck Canada is amazingly backwards if that's the case. So if you get stuck with a needle or a condom breaks you need to wait until you can see a specialist to get on post-exposure prophylaxis? Which has a 72-hour window to start, by the way.
- retrac 4y agoGo to the ER. Every hospital will have PEP starter kits, and easy access to an ID specialist. The biggest barrier to accessing PEP in Ontario in practice is cost. Most working age adults are not covered by public drug insurance.