Do you know if the Canadian Government subsidizes the cost in any way? (ie - prior to purchase where it would not be obvious)
No, it doesn’t. But there are federal controls on drug prices, such as restrictions on “unreasonable” increases (several criteria, such as that a price cannot increase more than the Consumer Price Index), and generally when a drug comes on market, it has to be roughly the same price as existing drugs in the same category. At the provincial level, there are further controls, such as drug formulary management, bulk buying of drugs for provincial health plans and by hospitals, preference by public and private insurance for generics, and limits on markups and dispensing fees.
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Tim - as Beacher mention, none of the pharmacy scripts are subsidized by the governments. I understand in parts of the UK gov’t healthcare pays a good chunk of prescription costs, but not in Canada.
@beacher - I’m curious if your cost for a vial of Humalog (or whatever insulin you take) is the same as Alberta’s. Not sure what province you’re in.
Jim
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The “prescription charge” in the UK is GBP8.80 per prescription. Normally if a chemist (US: pharmacist) has a lower cost for the item in the prescription then that is what you pay. There are monthly “pre-pay” arrangements apparently that cover all your prescriptions for a three months or a year at a fixed price; worth doing if you get one or more a month I think. If I understand it correctly that maxes out the prescription costs you will pay at GBP104 so long as you anticipate getting 12 or more prescriptions in a year 
That’s US$133 - a special low price brought to you by Theresa May and the brexit variety show.
T1Ds and others with chronic illnesses are exempt from the charge; well, I was in 1993, when I left the UK. IRC at that time you were also exempt if you were on the dole or receiving certain forms of aid due to low income.
The presence of the prescription charge has been a long standing cause of complaint in the UK; probably one of the widest spread complaints because it affects most people and it happens at a time when they get ill, when they least want it.
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With my last job I would contribute to my HSA all year just to be able
to pay for Jan, Feb, and March meds.
It should work out that you can pay half your total costs from HSA contributions; that might happen in 1 month or it might take 6, depending. If you are married and your spouse doesn’t have significant health costs HSA runs to the full cost, or close to the full cost.
This is because an HSA has to be associated with a “high deductible” ACA conforming plan and these plans have an OOPMax (out of pocket max) which is about $7000 (this year) while individual HSA contributions are limited to about $3000. For me I’m over 55 so I can contribute an extra $1000 and the combination of my and my wife’s HSA contributions therefore covered the OOPMax. Next year, remarkably, we seem to be in line for having extra in the HSA beyond my health costs.
Typically deductibles are irrelevant for “high deductible” plans because they equal the OOPMax and since you don’t pay anything after you hit the OOPMax they have a fixed cost; the premium cost plus the OOPMax. You pay the premiums after income tax and potentially up to half the OOPMax (approximately).
Given the shenanigans going on in the US health insurance/pharmacy industry as of this moment any T1D who is buying health insurance needs to get an HSA compatible plan, max out the HSA payments, and budget for the OOPMax.
The sticker shock comes from the fact that it happens at the start of the year, so you have to anticipate much larger health costs at the start. In my case that means I and my wife end up paying three times as much during the first 6 months than we do in the second; the premiums are constant but everything else stops in July.
The way I dealt with this the current year was to wait until the magic moment then hit my insurance company with all the stuff I had delayed; my Omnipod PDM (which was still working but out of warranty) and the Dexcom G6.
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In Ontario, a vial of Humalog is $36 (US$27), give or take a buck.
I think @Tim35 was maybe asking if the Canadian government subsidizes the industry, like it subsidizes the auto sector and aerospace companies. But I can’t find any evidence that it does.
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Actually any known subsidies of any sort.
Obviously very significant pricing difference so I was merely wondering if there was another source of funding that was perhaps behind the scenes.
Yes, it’s called the USA… where they pay 20x the price for everything so that the rest of the world can have it for almost nothing…
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Hi! I recently found out of a resource called PrescriptionHope. They work with your doctor outside of your insurance and are able to offer Humalog and other insulins for $50/month regardless of insurance, or retail cost. I know it’s not great, but I know that for some others I know it’s been helpful.
My OOPMax was $11K on the crappy plan so the burn continued throughout the year although at a slower pace after March when I hit the $3K deductible. I got close to but didn’t hit the OOPMax at the end of the year. When I got the offer for my current gig I didn’t waste any time in accepting even taking a $10K haircut because the insurance has no deductible, the highest copays for meds are $25/month, and the OOPMax is $3,500. DME copays are 10% so I got the Dexcom G6 for $65. I even took my HSA with me and have been paying the copays from it all year and still have about $300 left in it.
It’s crappy you have to consider an insurance plan before accepting an offer of employment.
The benefits provided by employment are absolutely on the table when I am negotiating whether or not to take a position.
During my last change of employment, I settled for a lower base salary then I could have had elsewhere due to the better benefits.
The entire compensation package needs to be evaluated.
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I have been working since the 1970’s (Oh my) the availability and quality of health insurance has always been an issue when changing jobs. When I owned my own company I offered good converage with subsidies for premeiums and I am talking a 20 person office. I valued my employees and their families.
Of course I understood that I was providing a great incentive for my employees to stay.
And of course it has been a major point of contention in most divorce settlements.
From experience !
When I got the offer for my current gig I didn’t waste any time in accepting even
taking a $10K haircut because the insurance has no deductible, the highest copays
for meds are $25/month, and the OOPMax is $3,500
Assuming you don’t have to pay any part of the premium out of your post-tax income that is definitely worth around $10k, possibly more. The comparison is with an individual plan which, for 2019, will have an OOPMax of at most $6500 but then requires the premiums in addition. In my case that comes to $15,408, but $9408 of that is premium - if your income is below the limit you can get the premium subsidy.
Health coverage is part of the package in the US, maybe the criteria are slightly different for T1Ds but surely everyone considers it before accepting a job offer? It’s the same as a pension plan but without the disappearing money effect of (401k) pension plans.
Anyway, the rise in health care costs and the fall in medium-sized employer benefits have fundamentally changed the math. The issue is that employer benefits can be grandfathered in to the ACA requirements and those benefits can actually be non-existent, or even negative, for us.
HSAs are extremely important for T1Ds at present. They’re like a health care equivalent of a IRA (individual pension plan) - they stick with us for life and, unlike an IRA, we can share some elements within the family; e.g. I can pay for my wife’s health expenses from my HSA and she can make her contributions to my HSA (though not the $1000 top-up.)
As I understand it Canada regulates the upper limit on prices charged for patentable drugs; so not insulin but insulin analogs, but it does not negotiate or, for that matter, subsidize, prices. (Is there anywhere that does subsidize prices, apart from the US, where there is a somewhat indirect subsidy?)
The CA regulatory authority has a broken web site:
The page that explains what they do seems to be missing, but so far as I was able to divine from other sources they take the prices negotiated in other countries. Thus while Canada does not itself negotiate a price it apparently second-sources other negotiations.
Canada does provide insurance; other countries like the UK and, IRC, most of Europe, do not; rather they pay directly and are themselves paid back by the people. Taiwan is another example which was insurance based at least until 2002.
So what matters with regard to you question:
Actually any known subsidies of any sort.
Is that there are not any subsidies. Rather there is a price capping mechanism based on prices charged outside CA. It sounds like the US model, where there is a price cap (in Medicare) based on prices charged elsewhere, but the US model uses prices charged in the US and therefore it is extremely easy to manipulate the cap by inflating the prices charged in the US retail market.
John Bowler
Correction to my post:
The “prescription charge” in the UK is GBP8.80 per prescription .
My apologies to the Welsh, the Scots and the people of Northern Ireland. For UK read England. The other parts of the UK of GB and NI do not levy a prescription charge. Clarification is here:
Strange, I have a recently purchased copy of “In Place of Fear” lying to the left of my keyboard.
It’s definitely worth the pay cut. My premiums are nearly the same but the coverage is so much better. I had to obtain a marketplace plan for two months while waiting for the coverage to kick in, we make too much to qualify for any subsidy so that was a bit of a ding but it’s all worked out.
We have an FSA at my current gig which is a use it or lose it unlike the HSA. I wish they would do away with FSAs and make them HSAs.
What Eli Lilley just said to me is that they would give me something to get me Humalog Kwikpens (which is what I use) at the cost of $95/month, regardless of what the prescription actually is. I said I was using 50IU/day, which is correct because I put 150IU into each Omnipod.
It isn’t clear whether or not this will count against the deductible/OOPMax on my (new) plan; if it does it will delay the hit when I meet the OOPMax next year probably well into the second half of the year. I still hit the max because of the Omnipods and the G6 sensors; even the CostCo rate on the sensors is $225/month and the Omnipods run at about $450/month.
Of course if moda won’t allow me to use it against the deductible then I’m going to end up paying an extra $95/month - i.e. my health costs will simply rise by $1,140 - because I’m still going to have to pay the OOPMax!
It strikes me as a publicity stunt - unless all our suppliers do it so that we don’t hit the OOPMax, it just costs us money.
So far as I can tell they only cover people with HDHPs (deductible $1350 or more for 2019, plus a number of other conditions) and people without insurance. There’s also something weird about CA and Humulin (I had to say I wasn’t getting Humalin from CA!)
BTW, my income last year was well above any income limit they might have so I assume there is none for the $95/month thing.
When I was employed the health plans were similarly generous; the tech industry had to offer really good health insurance to attract people. I didn’t do the FSA because at that time (1993-2001) the actual amount I had to pay myself was trivial. Insulin and test strips had a fixed co-pay (basically the same as generics) and I wasn’t pumping or using a CGM.
One interesting point is that I calculated the actual cost of treating a T1D was significantly less than the typical cost of an insurance program, so T1Ds were actually profitable to the insurance companies.
These days I can accurately predict exactly what I will pay in a year ($6000, exactly, next year) so the FSA would make sense because I also know I won’t be itemizing after last years tax changes. All the same, I agree completely; the use-it-or-lose it part sucks and makes FSAs useless for most people. Here’s an analysis:
http://time.com/money/4148183/who-keeps-unused-fsa-money/
John Bowler
Thank God for tax returns.
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