midnight000

Hello,

My wife and I live in the UK. We are thinking of living in Vancouver for a few years. I am trying to figure out whether we can get the same treatments in Canada that we do in the UK on the NHS.

My wife has severe asthma. It is controlled by a drug called Xolair that is given 4 weekly injections. I think it can cost somewhere in the region of £50K a year. In order to get this on the NHS they have to prove that all other treatment options have been exhausted. So, my question is how do i figure out whether this can be offered in Canada. Would it be through the state, or private medical insurance. If private, would they cover a pre-existing condition? I have been told employers pay for many peoples health insurance. How would that work in this instance, would I need to apply for jobs based on the medical plans they offer? How would I go about ensuring she has 'day 1' access to the drug?

Thanks
Jon

Former Lancastrian

With so little details provided my 1st question would be do you even qualify to live in Canada for a few years if neither of you are Canadian citizens.

midnight000

Hello,

The short answer is i haven't looked into it fully yet. The longer answer is I don't think that I would have any issues getting a working visa. I work in IT and am fairly well qualified. I have a masters degree and numerous professional certifications. I did take a quick look on the jobs listed as desirable for immigrants and I seemed to tick the boxes.

christmasoompa

Hi, welcome to BE.

Not sure what you mean by 'the jobs listed as desirable for immigrants', as there isn't a list of jobs in demand? A work permit will require an employer to pay, wait a few months and go through a lot of paperwork to hire you - and they'll have to prove that they have advertised the job across Canada and been unable to find a Canadian willing, or able, to do the job. Not saying that won't happen, but just so you are aware of the process, and if you are limiting your potential employers to ones with full private medical coverage, that may make things even trickier!

Does your wife normally have the injection at a hospital or just a pharmacy/doctors? This Wiki article may help get you started - https://britishexpats.com/wiki/Medical_Insurance-Canada And here's the BC Medicare website - https://www2.gov.bc.ca/gov/content/h...g-coverage/msp

midnight000

Thanks for the reply.

Only looking quickly I saw a list. I am not able to post urls yet, so I can't share. I was assuming I would need a job to get a visa.

I'll take a look at the links you sent. The injections are at the hospital.

BristolUK

In Canada this process (no other alternative treatment that works) is known as a Special Authority. In New Brunswick, this drug is listed as needing a Special Authority. Interestingly, for British Columbia a special authority is not listed as needed.
However, the systems across the different provinces are different and in BC, for drugs coverage (Pharmacare) you have premiums set according to income. There are also limits, sometimes, for what the Province will cover for individual drugs.

I imagine the reason BC doesn't insist on a special authority might be because they actually limit what they'd pay towards it. Perhaps there's someone in BC with more relevant experience and can advise better. Here's a useful link. https://www2.gov.bc.ca/gov/content/h...-drug-coverage

Of course, if you had employment with good health benefits, you might very well do much better but how practical that would be from day one is going to depend on your immigration route and that remains to be seen so far.

Siouxie

Medications have to be paid for in Canada.. unless given within a hospital environment (such as having had an operation or similar), under Provincial Healthcare, either through self financing or through 'medical health benefits' through a job - which you will likely have to contribute to and won't come into play until you have Provincial healthcare, generally speaking.

Excessive demand may come into play if you are hoping to become Permanent Residents, unfortunately, unless the your wife is ED exempt (i.e. family sponsorship - you are a PR or citizen of Canada) or you are able to pay for the treatment yourselves.

https://www.canada.ca/en/immigration...-services.html
https://www.canada.ca/content/dam/ir...report-eng.pdf
https://www.canada.ca/en/immigration...threshold.html

https://www.canada.ca/en/immigration...ssibility.html

Are you already PR's or Citizens of Canada?

midnight000

Hello,

So, doing a bit more digging. I found the below:Does Medicare Cover Xolair?
There are many Medicare recipients who receive Xolair to treat their asthma symptoms. In the majority of cases, Xolair is covered by Medicare Part B because Xolair is injected at a physician’s office. Part B (Medical Insurance) helps cover the costs of outpatient care, services, and supplies. It is optional, but many individuals choose to enroll in Part B when they are first eligible to avoid late enrollment penalties. You will likely pay a premium for Part B, and be responsible for a yearly deductible.

Medicare Part D helps cover prescription drugs as listed in each plan’s formulary, but because Xolair is not available at a retail pharmacy and is not considered a self-administered medication, Part D would likely offer no coverage for the medication. On the other hand, if Xolair is administered during a hospital admittance or while being cared for in a skilled nursing facility, Medicare Part A would be billed first. Patients who have a Medicare Advantage plan would also receive the same Part A and Part B coverage, but these MA enrollees may also have additional coverage.

So, can someone please explain how the different parts of medicare work? Is everyone entitled to get part B insurance?

christmasoompa

Are you sure this is for Canada? Sounds like it's referring to the US?

Silverdragon102

Not sure if this helps answering your question

https://www2.gov.bc.ca/assets/gov/he...xolair_dds.pdf

Atlantic Xpat

If you are looking at www.medicare.org then thats a US website. Nothing to to do with Canada. If you are considering BC then try here instead: https://www2.gov.bc.ca/gov/content/h...g-coverage/msp But your biggest hurdle is likely to be obtaining a Work Permit or Permanent Residency for Canada (assuming you are not a Citizen) where your wifes asthma might be considered too large a burden on the health system and preclude you from doing so. If you cross that hurdle you should understand that prescriptions in Canada are not covered by the state (generally) and unlike the UK we don't pay a fixed prescription charge, rather we pay the commercial cost of the drugs. Many have prescription drug coverage as part of private, extended health care coverage - in addition to the provincial medical coverage - that generally comes with employment. Employee and Employer pay premiums out of bi-weekly pay. Plans usually cover a percentage (in my case 80%) of the total cost of the medication.

scilly

As I read that last paragraph, it seems that BC will NOT cover the cost of Xolair.

But what I did notice was how long it took to get the decision .......... about 4 years.

BC is not known for making rapid decisions on covering the cost of a special authority drug.

Presumably there will be more applications from patients and doctors for a reversal of the decision ........... but it is going to take years.

I would think that this means that you will NOT be covered for your wife's injections ...............

midnight000

Thanks for the replies. The drug has only fairly recently been approved on the NHS in the UK, so this doesn't surprise me. I suspect we are UK bound for now at least. My wife had to jump through all sorts of hoops to get it here. (Multiple trips to A&E etc.) Covid does seem to have bumped respiratory issues up the queue a bit though.

scrubbedexpat091

Looks like your correct. Looking at the formulary website it is indeed listed as non-benefit, and if you further go into the definition of non-benefit this is what they (pharmcare website) sayNot eligible for PharmaCare coverage under any circumstances.

Special Authority is not available for these drugs.


OP: Newer or expensive drugs can often not be covered in BC, the government prefers older, cheaper drugs, my wife is in the same boat, can't access newer more effective drugs since they are not covered, sucks big time but its the way things are here.

Siouxie

It's not the drug itself that would be the issue - it's the cost of it - please see the links in my post upthread, unless your wife is Excessive Demand Exempt (i.e. you are a Canadian Citizen or Permanent Resident sponsoring her).