Financial Information

0Lung cancer, or any cancer for that matter, can be expensive to treat and manage. In a literature review conducted by the Canadian Cancer Society in 2010, findings found that most of the costs incurred by patients and their families were traced back to travelling expenses, out-of-pocket costs, and cancer drugs and prescription medicines.

The Canada Health Act says all Canadians ‘have access to the insured health services including all medically necessary hospital services, in-patient pharmaceuticals (medicines used while you are hospitalized), and medically required physician services [1].’ This means that medicines not used in-hospital (outpatients) are not always paid for, such as medicines that are taken orally by the patient at home [2].

This is meant to provide lung cancer patients and their families with information on the programs and services available to help them finance the cancer treatment and the costs incurred.

Mind the gaps: Expectations vs. realities for many cancer patients

Many Canadians expect their cancer system to work for them may significantly differ from the reality they may encounter. Depending upon the province, patients may be surprised to encounter five gaping holes in their provincial cancer systems [3]:

  1. Completely different provincial systems for IV and oral (or other take-home medications)
  2. Widely different timelines and waiting periods to commence IV and oral cancer medications
  3. Outdated paper-based systems in some provinces that, in 2014, still rely on hand-written prescriptions, mail and fax machines
  4. Lack of ability to track and report on usage, effectiveness and side effects of all cancer drugs
  5. Different levels of care: that not all cancer drugs are dispensed to patients by oncology-trained professionals

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The economic burden of lung cancer

In the Faces of Lung Cancer 2015 report, over half of caregivers reduced the number of hours they worked, and a further eight per cent quit their problems. Over 50 per cent of caregivers reported a negative impact on their household financial situation and with patients also understandably reducing their hours or unable to continue working, this can have a devastating impact on lung cancer patients and their loved ones [4].

In a US study by Mosher et al, lung cancer has been shown to be an even greater financial burden on families and support networks than other cancers due to ‘its high physical symptom burden and poor prognosis, resulting in expensive therapies and decrease workforce participation [5].’ In fact, a large US study reported that caregivers of lung cancer patients acquired higher costs over a two-year period following diagnosis than caregivers of patients with nine other cancer types [6, qtd. in Mosher et al].

Cancer drugs and prescriptions

Cancer drugs work to eliminate cancer cells, stop their spread and slow down the growth in different ways; drugs may also be used to lessen or relieve the side effects of cancer or treatments. In Canada, drugs are often paid for by public provincial drug plans, employer/private insurance plans, and/or out of pocket [7]. Still, cancer patients, caregivers and their families can find themselves paying exorbitant amounts for cancer drugs.

Drug coverage across the provinces at a glance

To highlight some of the inconsistencies in cancer drug coverage across the country, CanCertainty released a white paper by the Cameron Institute, a public policy think-tank, which details the patchwork of provincial cancer coverage [8]:

  • Canadians living in British Columbia, Alberta, Saskatchewan and Manitoba have their cancer drugs paid by the provincial government regardless of their age, income level or whether they are intravenously or orally administered
  • Provinces such as Ontario and the four Atlantic provinces do not primarily fund oral or injectable cancer medications. Patients needing take-home cancer medications fall back on a complex patchwork of partial assistance that may include their provincial drug plan (if eligible), private insurance (if any), manufacturers’ assistance programs (if any), fundraising (if possible), and personal savings and assets (if available) [9]
  • Through different funding methods, Canadians in Quebec have both intravenous and oral cancer drugs reimbursed regardless of age or income level
  • Oral, take-home cancer drugs are covered by the territorial governments but sometimes only with deductibles of less than $500

Cancer drug coverage in Ontario and Atlantic Canada

Only certain provinces and territories will pick up all of the cost of cancer drugs listed on their formularies; for example, patients in Ontario and Atlantic Canada are subject to different reimbursements. Even for those with private insurance, many patients and their families residing in Ontario and Atlantic are still paying high costs.

Drug offers information on reimbursement for prescription medications by providing information on types of private insurance plans, provincial/ territorial drug benefit programs, drug funding by provincial cancer agencies, and federal drug plans available in Canada.

Reaching out for financial advice from the healthcare team of the cancer patient is another excellent way to gain more information or point the individual in the direction of a pharmacist, pharmacy technician or social worker who can provide guidance [11].

Provincial drug plans and formularies

Formularies across the provinces

Health Canada drug product database – A database provided by Health Canada to search for drug identification numbers, product names and company names

BC PharmaCare formulary search – Provides a search engine for the formulary of BC PharmaCare and links to other cancer agencies’ formularies in British Columbia

Alberta drug benefit list – A formulary for the Alberta Health Care Insurance Plan; includes medicines covered under other plans

Saskatchewan cancer agency drug formulary – Saskatchewan Cancer Agency provides a formulary of the anti-cancer drugs and some supportive drugs funded by the agency

Saskatchewan online formulary database – A formulary of all the medicines covered underneath the Saskatchewan Drug Plan

Manitoba drug benefits and interchangeability formulary – A formulary for all the drugs which have been approved as eligible benefits under the Pharmacare drug benefit program.

Ontario drug benefit formulary/comparative drug index – A search engine that shows the formulary of drugs available under the various reimbursement programs in Ontario

Quebec list of medications – A formulary of the medications covered by Quebec’s basic prescription drug insurance plan

New Brunswick prescription drug program formulary – A formulary of the drugs which are eligible for benefits under the New Brunswick Drug Plan

Nova Scotia Pharmacare – A formulary that details the drugs and devices available for benefits under the Pharmacare programs in Nova Scotia

P.E.I. Pharmacare formulary – A formulary of the medications approved for coverage in Prince Edward Island as a public service

Newfoundland and Labrador interchangeable drug products and formulary – A formulary that lists the drugs which are covered by the Newfoundland and Labrador Prescription Drug Program

Nunavut non-insured health benefits program – The Extended Health Benefits Full Coverage Plan covers those enrolled in the Nunavut Health Care Plan and have a chronic illness or disease; this list approved prescription drugs

North-West Territories health centre formulary – The Extended Health Benefits Full Coverage Plan covers those enrolled in the Nunavut Health Care Plan and have a chronic illness or disease; this list approved prescription drugs

Yukon drug formulary – A search directory of the formulary for the drugs covered by the Yukon Insured Health Services

Provincial financial information and resources

Canadian cancer society – Financial help – The Canadian Cancer Society provides financial help and advice specific to the province or territory where the patient and family resides

Wellspring – Money matters – Wellspring provides information on government income programs, community resources and support to help cancer patients cope with the financial difficulty that can come with a cancer diagnosis.

BC Cancer agency – Financial and healthcare coverage information – Further financial information and assistance for cancer patients residing in British Columbia

CancerCare Manitoba – Financial arrangements – Services are provided by CancerCare Manitoba to help cancer patients understand Manitoba’s drug coverage programs

CancerCare Ontario – Cancer drug reimbursement – Information on programs that approve cancer drugs for Ontario patients that may not otherwise be available for reimbursement

CancerCare Nova Scotia – Finances and other concerns – Information and advice for cancer patients living in Nova Scotia

Cancer care foundation Newfoundland – Patient and family support fund – A support fund established to help cancer patients who are experiencing financial hardship

Federal programs

Federal programs and funding may be eligible for prostate cancer patients should they or a family member qualifies be employed be the Canadian Forces or fall under other criteria of the programs.

Canadian forces health services – The Canadian armed forces drug benefit list – A formulary of the drugs available for coverage to CF members and other eligible persons

Canadian forces health services – Spectrum of care – Medical and dental benefits and services – Further describes the health benefits and services available to CF members and other eligible persons

Interim federal health program – A limited temporary coverage of health-care costs to protected persons not eligible for provincial or territorial health insurance plans and when a claim cannot be made under private health insurance

Service Canada – Employment insurance compassionate care benefits – Compassionate care benefits are benefits paid to people who have to be away from work temporarily to provide care or support to a family member who is gravely ill and who has a significant risk of death within 6 months; a maximum of six weeks may be paid to eligible people

Health Canada – Non-insured health benefits – Provides a range of medically necessary goods and services to eligible First Nations (including registered Indians under the terms of The Indian Act) and recognized Inuit clients in Canada.

Veterans affairs Canada – Veterans Affairs Canada (VAC) provides a wide range of benefits and services, including prescription drugs, to qualified veterans, still-serving Canadian Forces members, RCMP members, and certain civilians as well as their dependants and survivors.

Medical expenses tax credit – Medical expenses that can be claimed for oneself, a spouse or common-law partner, or dependent children born in 1996 or later; if a patient or caregiver is spending more than 3 per cent of their income on medical expenses, then they can claim these expenses for the tax credit [12].

Health Canada – Disability tax credit – A person with a disability or their caregiver may be able to claim on their income tax and benefit return the deductions and tax credits; here is a list of what they could claim

Health Canada – Special access programme – The Special Access Programme (SAP) provides access to non-marketed drugs for practitioners treating patients with serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable

Private health insurance

The majority of Canadians have private insurance/third party insurance for prescription drugs as part of health benefits provided by their employers; most plans also cover the employee’s family or dependants. Employers purchase these plans from insurance companies and determine the terms of the plans for their employees.

Private insurance plans will cover some or all of the prescription medications that are used on an outpatient basis. This can include oral, inhaled and injectable medications, or some drugs for intravenous infusion used in an ambulatory setting. Private plans do not usually pay for medications used for patients staying in the hospital [13].

How to find out if the medication is covered

  • Phone the insurance carrier to determine the extent of your coverage
  • Supply the insurance company with the policy number or group health benefits number
  • Know what the drug identification number (DIN) of the medication [14]

Private health insurance resources

Health Canada – Drug product database – The drug product database contains specific information on drugs approved for use in Canada

Canadian life and health insurances association (CLHIA) – A full listing of Canadian insurance companies

Patient assistance programs (PAPS)

Pharmaceutical company-sponsored patient assistant programs (PAPS) help a patient find other payment options or provide financial assistance for their own drug plans; navigating private drug plan coverage can be challenging but pharmaceutical companies can provide trained staff members who help patients navigate their available coverage options [15].

Cancer centre coverage

Cancer treatment centres will sometimes provide financial assistance to patients in emergency situations when funding from other sources and services is not available. Contact the Patient and Family Counselling department at the nearest regional Cancer Centre and ask about financial assistance options available for patients.

Medical expenses and out-of-pocket costs

The Canadian Cancer Society identifies four groups of people as being most at-risk of suffering high out-of-pockets costs during cancer treatment: rural residents who must travel for treatments, those not covered with private insurance, those with high drug costs, and those who suffer a significant loss of salary [16].

Travelling for treatment can take a heavy toll on the finances of the patient and their family; in a study of 484 adults presented for cancer care at clinics in Newfoundland and Labrador, 19.5% of rural patients paid more than $1000 in travel-related costs for a single to access cancer care [17]. Factoring in the cost of meals, accommodation, and other medical care necessary for the patient

Further resources for out-of-pocket costs

Service Canada – Canada pension plan disability benefit – A taxable monthly payment that is available to people who contributed to the CPP and are not able to work regularly at any job because of a disability; the disability benefit does not pay for medications and assistive devices

Service Canada – Employment insurance sick benefits – EI offers up to 15 weeks payment for people who are eligible; this is based on how many weeks have been paid into the plan, and the payments are based on weekly earnings

London health sciences centre – Claiming medical expenses on your income tax returns – Info on what can be claimed as medical expenses on your income tax return, this can include travel costs, drugs and more

Canadian cancer society – Financial help – Depending on the province, the Canadian Cancer Society may be able to provide financial help with costs of travelling and lodging.