Curling 123

[Curling123]

Imbruvica appears to be the preferred therapy from reading these posts. As a senior and in Ontario, I wonder if it is covered by OHIP or Ontario Drug Program. Seems drugs if not administered in hospital are not covered even though many cancer drugs are taken orally now. Anyone from Ontario with CLL, a senior, covered? These drugs are very expensive. I have a private drug plan, but doesn’t cover the whole expense, especially if two drugs are needed.

[Hidden]

I live in USA. isn't Canadian medicine single payer everyone covered?

[Jemorgen in reply to Hidden]

Way more complex than that and I won’t do it justice but I can give a few basics.

The federal government transfers health dollars to individual province and territories who then administer as they choose within limits and guidelines. Each province or territory has their own list (formulary) of drugs they will cover - typically the basics within the general categories. Generic drugs are covered and brand names not usually although exceptions can be requested. Cheaper drugs have to be tried before more expensive, etc.

I’m not sure if all provinces are the same but BC has a deductible each year- sliding scale, means tested. Eg, seniors at the lowest end of the income bracket no longer have a deductible.

Many are lucky enough to have private insurance through their work that cover some of the drugs not covered by what we in BC call Fair Pharmacare, but mostly they cover the same (here’s where I get fuzzy).

Most of the basic cancer drugs are covered but newest ones not.

That’s a VERY simplified marginally accurate description of part of universal health in Canada.

[cllady01 Former Volunteer]

Curling, you asked this question 5 days ago and here is the link to the answers you got. You might want to bookmark this link or copy and print out the answers to have handy.

healthunlocked.com/cllsuppo...

[Hidden]

Just for your curiosity. I am on medicare part d in usa. My yearly co-pay for imbruvica will be 10,000 us dollars. 420 mg 28 pack 13 times. i started jan 7

[Cllcanada Top Poster CURE Hero]

In Ontario, Imbruvica (ibrutinib) is funded for some patients in first line use, through the Exceptional Access Programme... or EAP. It is generally funded for all second line.

You can read how this programme works and view the drugs listed and funding criteria, here:

health.gov.on.ca/en/pro/pro...

The ibrutinib criteria is as follows

Initial criteria for Treatment naïve patients with high risk CLL/SLL (First-line

therapy):

For patients with previously untreated chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) who present with one of the following cytogenic markers:

 chromosome 17p deletion; OR

 TP 53 mutation; OR

 unmutated immunoglobulin heavy chain variable region (IgHV)

Renewal criteria :Patient has experienced no disease progression while on Imbruvica therapy.

Initial and renewal approval period: 1 year.

Page 137

health.gov.on.ca/en/pro/pro...

💊

There are criteria that must be met. I have had Zydelig (idelalisib) through this programme and currently my horrendously expensive antifungals, lung meds are also covered...

~chris 🇨🇦

[Curling123]

Thank you everyone. Reason I posted again about it, was because I was in touch with Ontario Drug Program and they said thy didn't have Imbruvica or Venetodax on their list of cancer drugs. Will know more when I have my first appointment with specialist, Dr. Spaner, at Sunnybrooke. Thank you Chris for the contact.

[onu1tadi2 in reply to Curling123]

Hi Curling 123. I am going to be treated with imbruciva next. I first was treated with gazyva and chlorambucil. Remission did not last beyond a few months. I live in Toronto. I am positive Spanner will prescribe this for you unless you are in a specific high risk category in which case another form of treatment comes first and then you can get imbruciva. I am 73 years old and currently on no meds of any kind. I was at stage 4 when CLL was diagnosed. I visited Spanner at Sunnybrook for a second opinion but prefer to get treated downtown at St. Joe's as it is really close to where I live. I would really appreciate if you could report back on the treatment Spanner prescribed. You should also ask about Venetoclax which is considered the most effective drug currently. Good luck. You have chosen a great doctor who is also a leading clinical researcher.

[Curling123 in reply to onu1tadi2]

Hello, I am high risk with no symptoms yet and numbers aren’t too bad. I will be seeing him on April 26th. Will keep you advised if any treatment is required after tests, etc. Yes, I will ask about Venetoclax too. Less side affects I hear. Best to you with Imbruvica.

[rcusher]

I live in Toronto and have had FCR numerous years ago. When I relapsed was put on Ibrutinib. I am a senior and my only cost is the $100 deductible per year and maybe $2 part of pharmacy dispensing fee.

[Curling123 in reply to rcusher]

How long on Ibrutinib rcusher? Thank you for letting me know that it’s not going to bankrupt us. How are you feeling taking Ibrutinib?

[rcusher in reply to Curling123]

Hi, I have been on Ibrutinib for just over 1 year now. I have tolerated it very well with just minor stuff like cracking nails, muscle cramps for which I tag magnesium for which seemed to have helped with them, minor aches and pains. It has brought all my blood work down into the normal range. I am feeling great.

I go to North York General and my Oncologist/Haematologist has been excellent. I don't think I would've had any better care at Sunnybrook or PMH.

Maybe if things start to change I might have to seek the opinions of a CLL doctor but right now I couldn't be happier.

Hope all goes well for you. I try to keep up with as much info as possible, it helps me deal with my CLL.

I was diagnosed thru a routine physical in 2010 at age 65, had FCR approx 2 years later which put me in a remission for another 2 1/2 years.

I am Trisomy 12 which means not good but not bad either.

[Curling123 in reply to rcusher]

Good to see you are doing well with Ibrutinib. Looks like you are in good hands with your doctor too. I was just diagnosed in Feb this year. A new journey. I have 17p,11q, 13q. Not the best, but hope for the best. Wishing you well. This forum is so important and such a learning curve.

[rcusher]

One other thing and I don't now if it makes any difference is that I have my blood work done at the hospital and meet with my doctor.

[Curling123 in reply to rcusher]

Where are you located? Do you see Dr. Spaner as well at Sunnybrooke?

[Marisa50]

My aunt's co-pay with Medicare was $2,500 per month and she has a great plan. However we were able to very easily get grants through the leukemia society. From what I understand it's not that difficult to get grants and the pharmacist practically did everything. she goes to her oncologist private office every month and gets pills to take home for the month it is not administered anywhere. She takes them daily. I don't know if being in a hospital makes a difference. You may want to look into grants. Although I don't know how it is in Canada. Good luck with everything and I hope that you do wonderfully.....

[onu1tadi2]

Yes. Imbruciva is covered by OHIP once first line of treatment fails