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Health Insurance Coverage

To minimize your own out-of-pocket costs, some research may be necessary to ensure you have optimal access to new prescription medications.

  • Drug coverage and drugs provided through cancer care centres can also vary from province to province.
  • Meet with your employer, your Human Resources department or union representative to help you better understand your benefits.
  • If your employee health plan does not cover a certain drug, ask your employer if the company can make an exception in your case, or waive the cap on your drug coverage.
  • Ask your doctor what drugs you may need in the future and check to see if your plan covers them.
  • Some private insurance plans require that you pay up-front and then apply for reimbursement. You may ask your insurance company to allow your pharmacy to send the bill directly to them.
  • Find someone to work with you to advocate for the drug coverage when you cannot.
  • If you are refused coverage of a medication you need, appeal the decision. Sometimes the refusal may be the result of nothing more than faulty paperwork.
  • Some pharmaceutical companies have free services that will help you search for coverage of specific drugs. Sometimes a compassionate use program is offered to patients requiring the drug. Talk to your cancer care team.

 

Questions for your Healthcare Team

  • Will I have to pay for any part of the trial such as tests or the study drug? If so, what will the charges likely be?
  • Will there be any travel costs that I need to consider while I am in the trial?
  • What will my health insurance likely cover?
  • Who can help answer any questions from the insurance company?