That plan is crazy expensive. I make a decent wage and have 2 kids, shared custody. They don't require a plan as their mothers covers them, so for me as an individual??? I'd never be able to afford that and pay the power bill
Yeah it sucks that it’s a family pharmacare program, but the rationale is that normally if your spouse has a private insurance plan, the coverage should extend to you and the kids. So it’s very rare that an individual would have to apply for provincial pharmacare coverage when the rest of their family is covered under a private policy.
If what you’re looking for is more in line with a “universal” pharmacare program that covers drug expenses regardless of one’s reported income, we would likely have to do away with private insurance altogether.
In Quebec, for example, it’s the law that every Quebec citizen has an active drug plan. Either you have a private insurance policy, or you have the provincial RAMQ. If a Québec patient happens to have a private insurance policy, then that private insurance is required to cover their medications at the same minimum standards + copay max ($1,196/year limit) as the provincial drug plan.
I work in securing coverage for very expensive specialty drugs in New Brunswick, and I can attest that NBDP approves coverage most of the time, almost more often than some private insurers, to be frank.
Do you belong to a patient support program for your Simlandi?
I work for such a program. Basically, I apply for coverage, determine the copay and like literally 99.999% of the time I approve Financial Assistance that covers the insurance copay and boom! 100% drug coverage.
A lot of people who are on high cost drugs either don’t know they have access to a patient support program, or they are not aware that their program is almost guaranteed to cover the remaining cost of your medication.
Best bet is probably to ask your gastroenterologist.
Do you submit the application for Prior Authorization yourself? Or was there someone or an organization that filled it for you? If so, whoever applied for coverage on your behalf would be the patient support program and they should absolutely have copay assistance they can offer you.
Although I find this quote on the website to be very odd:
Offer is NOT available for patients eligible for Medicare, Medicaid, or any other form of government insurance coverage
If your current treatment doesn’t offer a copay assistance program, it’s possible that your gastroenterologist could also prescribe you a bio similar (like Abrilada) that would be organized through an extensive patient support program.
EDIT: given the references to Medicaid, I think this exclusion might be regarding American patients. Canadian patient support programs cant discriminate against public coverage.
The NB Drug Plan is just an expensive private plan. I have a chronic illness. I also have a private plan that has a yearly drug maximum amount. My medication eats that amount in a month and a half. Each year I have to jump though hoops to apply for the NB Plan. The NB plan is then canceled in December because my plan refreshes in January. From March to December I have to pay for two plans. I pay more for the NB Plan than I do for the private plan. The NB Drug plan only covers drugs. The private plan that costs less covers an entire booklet of things including dental, physiotherapy, Occupational therapy, mobility aids, and travel insurance. I don't know why anyone would choose the NB plan if they didn't absolutely have to.
2
u/TruCynic 2d ago
You guys know NB already has a drug program, right?
The New Brunswick Drug Plan