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Prostate Cancer | Last Active: Aug 27 4:05pm | Replies (23)
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Forgot to mention that next year, the Medicare cap will be $2000. After that, you pay nothing.
Replies to "Forgot to mention that next year, the Medicare cap will be $2000. After that, you pay..."
Probably not that simple. My understanding is that CMS is in scramble mode because of this cap. Insurors, predictably, planned to make up for the lost revenue by increasing premiums proportionately. This being an election year, the Biden administration came up with some enormous lump sum to make up the difference to the insurors. Of course that money doesn't cost anything, right? 🙂
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That's good. Our system in Ontario is convoluted right now, but they're in the process of simplifying.
1. If you have private insurance (e.g. through work), they're the first payer.
2. Next, if you're < 25 years, 65+, on social assistance, getting homecare, or in the hospital, the Ontario Drug Benefit (ODB) will pay for your meds.
3. If you don't qualify for the ODB, then you can join the Trillium Drug Benefit, which will cap your prescription payments to 4% of your previous year's household income. Often, cancer drug makers will cover that 4% for you.
4. If your med is so new that it's not in the Ontario formulary yet, most drug makers have patient-access programmes that will cover the full cost.
Incredibly, I went through all 4 of these channels at different times for Erleada. My supply was never at risk, and I never had to pay a penny, but I could have done without the extra hassle. It will be great when universal pharmacare arrives (it's on the way).