Managing Costs of Medicine

for Inflammatory Bowel Disease (IBD)

* G – Generic product, B – Brand name product

KEY POINTS:

  • Medicines used to treat IBD vary in cost ranging from relatively low cost (for example, prednisone), to moderately costly (such as 5ASA enemas), to very costly (such as the biologicals) 

  • Your pharmacist can provide information about the costs of different medicines and about coverage through provincial health plans.

  • If the cost of medicine may be a problem for you, be sure to let your doctor and pharmacist know.

  • See the tips for managing the cost of medicine below.

  • Be sure you understand the instructions about taking the medicine.   Ask your pharmacist or doctor if you have questions.

Tips to manage the cost of medicine:

 

  1. Ask your pharmacist about the cost

 

  • Most doctors are happy to discuss the cost of treatment with you.

  • Be clear with your doctor if you cannot afford a medicine.  If your doctor thinks you will be following a treatment plan and you don’t fill the prescription the effect on your health could be serious.  If the cost is a problem, your doctor may be able to suggest a different treatment approach.

 

Use one pharmacy regularly: Your pharmacy has a record of the medicines that you take and can help with information about them.

Table 1: Estimated Monthly costs for common medications used for IBD Non-Biologics

Table 2. Estimated Annual Costs of Biologics (anti-TNF medications & others) –  Year 1

2. Managing the Cost of Medications

          

  • Some of the medicines used to treat Crohn’s disease and ulcerative colitis are very costly. Biologic drugs are among the most costly – with a cost in the range of $25000-40000 per year, depending on the drug and the dose.  Speaking to your pharmacist or a pharmacy team member prior even prior to visiting the gastroenterologist is often very helpful in expediting approvals and ensuring you are reimbursed for medication costs once therapy is started. All Canadians are eligible for at least one drug plan that may offset some or all the cost of these medications. Private plans and provincial drug plans can have co-pays or minimum annual deductibles.

  • Many times, once a drug is dispensed you cannot go back in time and have a drug plan cover the cost of the medication. Make sure you are registered with the drug plans you are eligible for. This applies especially with the provincial drug plans. The pharmacy staff can help you check if you are registered ahead of time.

  • Many expensive medications require the gastroenterologist to submit approval documentation prior to the drug being dispensed by the pharmacist. Confirm with the gastroenterology office staff if this is the case for any new prescription medications.          

  • If you have extended health insurance that covers prescription drugs, it is wise to check in advance about which drugs are covered.  Your pharmacist or the plan administrator in your organization may be able to help with this.

  • Most provincial plans have a minimum deductible payment for annual drug costs that is based on income. You will have had to be up to date with having filed your income taxes to be eligible for the provincial pharmacare plan. There may be options to spread the cost of the prescription over a 12-month period if the prescription is very expensive for your monthly income. The pharmacy staff can help direct you to what might be available to you.

  • There are no federal plans to cover biologic drugs other than the Non-Insured Health Benefits (NIHB) Program that provides drug coverage for First Nations of Canada. There are private plans accessible to many federal government employees.

  • The company making a high cost drug (such as biologics) may have a plan to help people if they have difficulty managing the cost. Some pharmaceutical companies may even provide some drugs on a compassionate use basis if they are unaffordable to patients. Your gastroenterologist should know which medication may be available for one of these programs.

3. Dispensing fees:

  • Pharmacies charge a dispensing fee for each prescription. This pays for the pharmacy services including navigating then billing drug plans on your behalf, making up the prescription, providing advice about the medicine, checking it is safe to take this along with your other medicines, and monitoring your health. A pharmacist may call you a few days after starting a new medication to ensure things are going well.

  • Dispensing fees and mark-ups vary between pharmacies. In Manitoba, dispensing fees usually range from $4.49 to $15.00. Check the dispensing fee by visiting or phoning the pharmacy. The dispensing fee is usually the same whether you get a prescription for three days or three months.

4. How Much medication should I get at a time?

  • It depends, one thing to remember is that once dispensed to you, medications cannot be returned to a pharmacy for credit - even if that box or vial the medication came in is unopened. That is the law.

  • Once you have taken a medicine for a while, are on a stable dose, and find it helpful, ask your doctor to write a prescription covering a longer period if possible. Usually the longest period supported by insurance plans is about three months (90 to 100 days).

  • If your doctor or pharmacist is reluctant to provide prescriptions for three months at a time, there may be a good reason for this. Often it is to ensure that you are getting the appropriate blood work that must be monitored with that medication or to ensure you are not out of pocket for an expensive medication that you may not use all of. Dispensing fees are paid out of drug plan deductibles so if you are on an expensive medication and reach your annual deductible there is no annual savings to you with getting large quantities at a time. 

  • Any pharmacy can safely dispose of any unused medications for you.

 

 

Last reviewed: September 2020

For more information and fact sheets about IBD and its treatment please visit: http://www.crohnsandcolitis.ca

Disclaimer: This information is provided for educational purposes only. Always consult a qualified health care professional for your specific care.

Source: This summary provides scientifically accurate information.  It was prepared in a research review by researchers with the IBD Clinical and Research Centre, University of Manitoba with assistance from colleagues in Canada and internationally.  Dr Peter Thomson provided up to date information for this information piece.

 

Acknowledgement:  Preparation of this material was supported by funding from the Canadian Institutes of Health Research. 

©2016 Charles N. Bernstein, John R. Walker on behalf of Manitoba IBD Clinical and Research Centre. This work is licensed under a Creative Commons Attribution-nonCommercial-NoDerivs 2.5 Canada License.  You are free to copy and distribute this material in its entirety as long as: 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes, 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/.

Note: Estimated cost in Manitoba pharmacies 2020.  Specific costs will differ in for different doses and different pharmacies.

© 2017 The IBD Clinical and Research Centre

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