Coverage of Biologic Medications
My physician is planning to start me on biologic medication. Are these medications covered by private insurance plans or by the government?
Coverage is available for biologic medications through private insurance plans and the government based on meeting specific criteria which includes: the type of medical condition being treated, the level of disease activity and the medications that have already been tried. Our clinic billing coordinator works very hard to submit all the information required to private plans and the government to get the best coverage possible.
How long does it take to get approval from the government or private plans for biologic treatment?
Once the physician has determined the appropriate medication for you and submitted a prescription to the clinic, our staff submits the necessary documentation to the government and any private insurance you may have within 24-48 hours. Approval for billing the medication can take between 2-4 weeks. In emergency situations, pharmaceutical companies may offer compassionate supply to help initiate treatment earlier.
If my private plan only pays a portion of the cost of the biologic treatment, will the government pay for the rest?
The government may pay for the balance of the medication cost should your private plan not pay for 100% of the medication cost. This will depend on the amount of coverage the private plan is offering in combination you’re your age and household income. Applications to both the government and your private plan are coordinated by the clinic on your behalf.
I have no private plan. Will the government pay for the entire cost of the medication?
The government has covered the entire cost of the biologic medication for patients with no private insurance plan based on meeting specific criteria regarding age, household income and if you have a disability that prevents you from working. The billing coordinator will make help to ensure all the documentation needed is submitted on your behalf to get the highest level of coverage possible.
Delivery of Medication
How do I arrange delivery of my medication?
A clinic coordinator is assigned to arrange delivery of medications directly to your home. As soon as your physician orders the medication and the billing is approved, you will be contacted to arrange a delivery to you.
Can you deliver to my place of work or a neighbour if I am not going to be home?
If you wish the medication to be delivered to a different address than your home, please contact the clinic at least 24 hours before your scheduled delivery time. If someone other than you is receiving the medication you must inform them that a delivery is coming and ensure they are aware of the refrigeration requirements. A signature is required for receipt of the medication.
What if I forget about my delivery and no one is home to receive it?
Pharmacies are legally governed to not leave medication outside of a person’s home (mailbox, porch). All deliveries must be signed for as received. To avoid missed deliveries, our staff will contact you a few days prior to delivery to ensure you still requiring your medication and to confirm a delivery time. If you feel you have missed a delivery, contact the pharmacy immediately and we will make every attempt to come back to your home if we are still in your area. Realize however, that if you are not home at the time of delivery, the medication will be brought back to the pharmacy and re-delivery may not be possible until we are back in your area.
How long can my medication stay out of the refrigerator?
Biologic medications are to be kept refrigerated. They are delivered with cold packs to maintain the required temperature. Some biologic medications can be left out of the fridge for a short period of time and others cannot. Please contact the pharmacy for specific storage conditions.
How do I store my medication while travelling and do I need to carry documents about my mediation to cross the border or get on a plane?
Travelling By Plane:
It is important to keep your medication with you in your “carry-on” luggage. Use a small, insulated cooler bag with ice packs to keep the medication cold until you arrive at your destination. Ensure there is a fridge in your accommodations. When going through security, carry a letter from your physician outlining that you are carrying injectable medication required for your medical condition. You may wish to check with the airline to confirm any specific criteria they may have, as “needles” could be seen as a potential weapon.
Travelling By Car:
Use a small, insulated cooler bag with ice packs to keep the medication cold until you arrive at your destination. Ensure there is a fridge in your accommodations.
If you are crossing the border ensure all medication is properly identified with the original prescription label. Carrying a note from your physician regarding the medication you are taking and your medical condition may be requested in the case of a car search.
I have been ordered a medication that must be infused at the clinic. How long will I be at the clinic?
The first time you come for an infusion, you may be at the clinic for a longer period of time than you will for subsequent visits. Infusion times vary between the different medications. The majority of patients allow for 2 hours while some infusions may be done in 1 hour while others may require up to 6 hours. You may contact the clinic to obtain specific details of your infusion.
Will I be able to drive home after my infusion?
Depending on which medication you are receiving, there may be a need to give an antihistamine prior to your treatment which can cause drowsiness. Please check with the clinic before your infusion to see if you will need to make arrangements for a drive home.
Can I eat regularly before and after my infusion?
We encourage you to eat your normal diet before and after infusions. We do encourage you to drink 2 glasses of water before your infusion. If your infusion is running over a few hours, you may wish to bring some snacks with you. Coffee, tea, water and light snacks are provided at no charge during the infusion. A small café is located within the building at the Charlton Centre main location in Hamilton should you wish to purchase lunch or breakfast.
Can I take my regular medication before an infusion?
Generally we suggest that all maintenance medications be taken as per your normal routine. As some infused medications may cause a fall in blood pressure, the clinic nurse may ask you to bring your blood pressure medication with you and not take it before coming to the clinic. Some biologic medications may cause an increase in blood sugar readings in patients who have diabetes. This is a short- lived affect and monitoring of blood sugar is suggested.
What can I expect after and Infusion?
Many patients experience no adverse effects after an infusion. However, headache, itchiness, a throat tickle and fatigue can all be experienced on the day of an infusion and may persist for the following 24-48 hours. If you experience any reaction that doesn’t resolve within a couple of days or is unknown or concerning to you, please contact the clinic. Reactions that are experienced after a first infusion become minimal with subsequent infusions.
I have been prescribed a medication that I must inject at home. How will I be trained to give this injection?
Our nurses and pharmacists are trained to teach proper injection technique to patients. The training can be done at one of our centres or can be arranged at your home. After the initial training, you may wish to come to one of the centres to review technique or have one of our staff do the injection for you. We are happy to offer this service for as many visits as you require.
What can I expect after injecting a biologic/specialty medication?
Many patients do not experience any adverse effects after their injection. At the site of injection, some redness, tenderness and swelling may occur for 24 hours. Generalized fatigue or malaise can be experienced for 24 hours after an injection. If you experience any reaction that doesn’t resolve within a couple of days or is unknown or concerning to you, please contact the clinic. Reactions that are experienced after a first injection become minimal with subsequent injections.
The Internet and Other Resources
I have read a lot of information from “chat groups” about biologic medication that I found scary. How valid is this information?
It is important to realize that there is more benefit than risk to biologic medications or they would not be approved medications in Canada. Treating a medical condition can be extremely vital to improving quality of life and this has far reaching health benefits. There are many well-respected websites that provide good quality information that is written by health professionals. Chat groups tend to represent the few people who are having difficulty with a medication and not the large proportion of people who are doing very well with treatment. Please refer to our resources section, as it offers validated sites for accurate information.
What vaccinations can I have while on biologic medication?
Live vaccines cannot be given while on biologic medication. This includes shingles vaccine, MMR and Yellow Fever. All other vaccines can be administered during treatment although the protective effect of the vaccine may be lessened. Annual flu shots are suggested. Our clinic has developed a protocol for vaccination prior to initiating biologic treatment and during treatment. We encourage patients to have all their vaccinations up to date prior to starting biologic treatment. The shingles and pneumococcal vaccines are also suggested prior to treatment initiation.