The prescription drug landscape has undergone a significant transformation over the past 10 years, but many people still aren’t aware of the impact of those changes, or how to deal with the changes, should they be impacted.
New high-cost, specialty medications called biologic medications are becoming a lot more prevalent for a few reasons: first, new medications are being introduced into the marketplace to treat illnesses that were previously treated with lower-cost chemically synthesized drugs. Second, existing medications are being used to treat a more significant number of conditions.
These medications can cost upwards of $30,000 to treat relatively common conditions and can exceed $300,000 per year for rare diseases.
The consequence of these drugs hitting a private group plan is significant. Even though the group benefits industry has introduced strategies to help spread the cost of these high claims, they can still translate into skyrocketing plan costs.
To protect themselves against the risk of these high claims, more and more companies are implementing drug maximums into their programs.
Here is your guide to the programs in place to help with high-cost medications should you or someone you love require treatment:
Alberta Blue Cross Non-Group Program or pharmacare programs: Against the backdrop of our national debate surrounding a country-wide pharmacare strategy, it may be easy to lose sight of the fact that every province currently has in place a program. Some are mandatory for all residents.
In Alberta, families or individuals have an option to enroll in the Alberta Blue Cross Non-Group program, a government-funded program administered by Blue Cross. This program does not cover every medication, and you can check whether your specific drug is covered by searching the Interactive Drug Benefit Listing. The drug maximum is unlimited, so even with the monthly premiums, the coverage is very affordable.
Other drug programs are also available for rare diseases as well as cancer patients.
Patient Assistance Programs: Drug companies are well aware that certain medications are simply affordable for those who find themselves without drug coverage or with drug maximums.
Phoning the manufacturer or working with your doctor and pharmacist can help you access patient assistance programs that may offer relief through reduced or even free
RxHelp.ca: Mandatory generic plans are becoming much more common among companies that are trying to control drug costs. Meanwhile, certain people simply prefer taking a brand name medication.
If this applies to you or someone you know, check out RxHelp.ca. The free downloadable card allows patients to benefit from payment assistance on their brand-name medication. The list of covered medications varies by province.
Navigating our new drug landscape can be daunting if high drug expenses impact you or someone you know. Knowing that options exist to manage these costs and help ease the burden.