Talking Allergies

I came across the term "provincial formulary" on the Twinject Canada FAQ page (it was used in reference to provincial coverage for Twinject) . In Ontario our provincial health plan (OHIP) doesn't normally cover the cost of prescription medication (for the average Joe) so I was intrigued and dug further. Well -- I opened up a really good can of worms.

I discovered the Trillium Drug Program, and it is available to those who live in Ontario and qualify for OHIP. This is not just a program for low income families. It is a provincial insurance plan without insurance premiums. There is no cost to apply or to be accepted into the program. It is for people/families who do not have any private drug insurance or are only partially covered by their private insurance plans. This plan only covers prescription medication but does say it includes "nutritional items" (worth looking into further for the food allergic/celiac). They use the family's annual income and the number of family members to determine a "deductible" that is payed quarterly throughout the year in the form of prescriptions you pay for in full. Once the deductible is paid, all drugs for that quarter are free (I think you pay a $2 fee per prescription). Medications that are covered by the program are in the "Drug Formulary Book" (you can call 1-800-668-9938 to find out which meds are covered or check online using one of the links I've provided below). There is an appeal process called a Section 8 if there is a drug you need that isn't listed. The program starts from August 1st to July 31st and uses your annual income/tax information from the previous year to determine your deductible (you can also check on line to determine what your deductible would be for your family). But when you first apply, you can decide when you want the program to start and they will pay for drugs retroactively if the drugs qualify. So -- it's December now, I have prescription receipts that go back to September, I can request that my "start date" is September, and they will issue a check retroactively (once my deductible has been paid). I really suggest that all of you who live in Ontario and who do not have drug plans (or only partial coverage) go to the links and read more about it -- it can only benefit you. Even for families that don't normally use a lot of meds, with epinephrine and asthma meds, you all know that it adds up quickly (especially if you have more than one child). It's really worth looking into further. I know I'm rambling...but I get excited when I find out about resources like this. I wonder why none of my doctors pointed me to it (knowing we didn't have insurance)? Maybe other provinces have similar benefit plans?

http://www.health.gov.on.ca/english/pub ... llium.html (government site)

http://www.drugcoverage.ca/p_benefit_on.asp (general info site discussing provincial drug coverage across Canada - not a government site)

I had never heard of this either---thanks for the info.!

I had heard of the Trillium program, and even know of someone with severe allergies/asthma and a limited income who has benefitted from it - I just didn't know the details. Thanks so much for posting this, ethansmom!

We live in Quebec, and I believe Quebec has a decent public drug insurance plan for those without private insurance. (I haven't had any experience with it because we've always had private insurance through an employer.)

At http://www.ramq.gouv.qc.ca/en/citoyens/ ... blic.shtml it says this:



You can get more info by going to that site and clicking on the other links. I did a quick check and it does cover things like EpiPen, EpiPen Jr., Twinject, Flovent, and Ventolin.

K.

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Karen, proud Mom of
- DS1 (12 yrs): allergic to cashews, pistachios, Brazil nuts, potatoes, some legumes, some fish, pumpkin seeds; OAS
- DS2 (1o yrs): ana. to dairy, eggs, peanuts; asthma

Karen it sounds as though Quebec's public plan is more inclusive than Ontario's. I've been meaning to post that I did my own searches using the on-line formulary search tool to see if some allergy/asthma meds were covered under the Trillium Drug Program. Some asthma meds did come up as covered but I was unable to find EpiPen or Twinject. I sent the makers of EpiPen an email to verify and they confirmed that they are not currently registered with the Trillium Drug Program. I found this on the Twinject website under FAQ's:

Despite Twinject's website info., when I did my search, Twinject did not come up as being covered. I sent Twinject an email to inquire and when I did not get a response, followed up with a phone call and left a message. This was a while ago, and to date I haven't received a return email or phone call. I was told by the pharmacist and doctor that you could submit a Section 8 appeal through your doctor and the program should cover epinephrine. It does irk me though, that Twinject has this info on their website and it doesn't seem to be the case. Also -- not thrilled that they didn't respond to my queries.

bump

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy and green beans) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: Oral Allergy Syndrome, Allergic to Birch trees

bump

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy and green beans) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: Oral Allergy Syndrome, Allergic to Birch trees

FYI - If you are having a hard time affording your auto-injectors, contact your provincial drug benefit program.

I recently sent an e-mail to the Ontario Ministry of Health:


this is the response that I recieved today:

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy and green beans) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: Oral Allergy Syndrome, Allergic to Birch trees

DrugCoverage.ca is dedicated to helping Canadians access reimbursement for prescription medications by providing information on the various types of Private Insurance plans, Provincial/Territorial Drug Benefit Programs and Federal plans available in Canada.

http://www.drugcoverage.ca/default.asp

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy and green beans) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: Oral Allergy Syndrome, Allergic to Birch trees

I am aware that not everyone has access to drug benefits. The cost of an EpiPen/Twinject as well as a MedicAlert bracelet (all of which I consider to be essential) can be off putting. I would hate to think that someone is resistant to use their emergency medicine due to financial constraints.

I came across this information on a local school board site and found the other school board has a similar program. I suspect that most school boards have a similar program. Also, the Trillium Drug Program will assist in the cost of epinephrene for those who qualify. (Epipen/Twinject are not listsed as covered but upon further investigation I have found they will cover it.) http://www.health.gov.on.ca/english/pub ... llium.html

CEFO provides immediate assistance to impoverished children and their families through the Emergency Response Fund. This 24-hour turnaround assistance includes the provision of eyeglasses, EpiPens, medical supplies, food and clothing, transportation, and many other financial needs resulting from family crises.
http://www.catholiceducationfoundationo ... .php?sec=0

Over the past year, the Education Foundation of Ottawa (EFO) provided over $140,000 to pay for winter coats, boots, running shoes, hats and mitts, food vouchers, emergency medication such as Epi-pens and other urgent medications where the family cannot afford it, emergency transportation, and field trip transportation for thousands of low-income students in the Ottawa-Carleton District School Board.
http://www.educationfoundationottawa.ca/

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy and green beans) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: Oral Allergy Syndrome, Allergic to Birch trees

Great find Susan, wonderful that that service is there for those who need it.

Has anyone every submitted their epi case to their benefits plan? I strongly believe a portion should be covered as it is a medical device holder.

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DD 12 yrs -no allergies
4 yr old DS - asthma/eczema Anaphylactic to Peanuts, all tree nuts, sesame , all pea/lentil legumes, gelatin.
Allergic to trees, grass,ragweed, feathers, dander, mold and dust.
Outgrew eggs, fish, shellfish

http://www.rxassist.org/pap-info/compan ... ?CmpId=245

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy and green beans) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: Oral Allergy Syndrome, Allergic to Birch trees

In the USA, U.S. National Library of Medicine lists several government programs and nonprofit organizations that may be able to assist.

They also suggest discussing your concerns about paying your medical bills with your health care provider, social worker or the business office of your clinic or hospital.

http://www.nlm.nih.gov/medlineplus/fina ... tance.html

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy and green beans) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: Oral Allergy Syndrome, Allergic to Birch trees

A bit late to answer, but....

It is not covered by our plan. We do have a very good plan.

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self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings

It's a bit of an overstatement by twinject.

In Ontario Epi-pen IS covered by the formulary. twinject IS NOT covered.

To get it covered, you have to get a letter from your doctor explaining WHY you need that one instead of the one that is covered.

Our policy is through dh's work. Things covered under the provincial formulary are covered at 90%, all others are covered at 50%. It cost me a lot of money to find out the twinjects I purchased were only covered at 50%.

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self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings

Now the stuff is hitting the fan.
viewtopic.php?f=48&t=7331

Inteliject???

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Myself - Seasonal, cats
dd-asthma (trigger - flu) anaphylactic to eggs, severe allergies to bugspray and penicilin,pulmicort
ds-Seasonal, cats and OAS
dh-allergy cats, bugspray and guava, outgrew egg allergy