Canada’s medicare doesn’t cover drugs. Provincial drug benefit programs fill in some of the gaps, but often have very limited formularies. Two of the drugs I take aren’t on my province’s formulary at all, two are non-benefit (they thought about covering it but decided not to), and one of my drugs is so new they haven’t decided yet whether they’re going to cover it.
Three of my medications are covered. These drugs cost me about $30/year. The others run about $18,000/year.
But, as a lucky person, I currently have private insurance to pick up medicare’s slack. As a very lucky person, I’m actually covered by two plans and my most expensive medication (~$13,000/yr) is free for the next 8 months through a drug company program.
But to get those insurance companies to cover ~$3000 of the remaining $5000 of drug costs, I have to do a lot of paperwork, and I have to get my doctor to do a lot of paperwork.
In addition to being a huge invasion of privacy, why the fuck should my doctor have to explain to an insurance company why they’re prescribing me something? Is the insurance company going to notice an error in the prescription? Do they know more about my health and medicine and have a better idea? No – the doctor is a doctor, the insurance company is a fucking soulless rentier who has no medical expertise what-so-fucking-ever.
The insurance company is banking on the paperwork process being enough of a hassle to stop most people from getting the coverage they’ve paid for. Determined folks might get through the first few steps, but it takes a truly broke and organized and maniacal person to finish the process – especially once the first denials come back.
And then you have to repeat the process every policy year.
There’s a shortage of doctors in my area. My GP retired in January and I’ve been looking since then for a new one with no luck. There’s not even a waiting list I can get on. So I go to the overwhelmed student clinic where appointments can take a month or more to get and last 10 minutes.
Instead of talking to my doctor about how to better manage my medications’ side effects or risks of a treatment that’s otherwise working well, she’s going to spend the appointment filling out repetitive forms justifying her professional medical opinion for two insurance companies.
I spent two hours today doing insurance paperwork and expect to do hours more, my doctors are going to spend at least half of my next 3 appointments doing insurance paperwork.
Private insurance is a drain on the public healthcare system in Canada and the utterly pointless and overly detailed paperwork they force patients and doctors to do over and over again is just the tip of the iceberg. I’d like to see it banned entirely and I’d definitely like to see Canada (and the US!) ban insurance companies from requesting justifications from healthcare providers for prescriptions and other treatments.