The Charlton Centre

Living with an immune-mediated condition can be a difficult journey with many different treatments. For instance, patients with rheumatoid arthritis may begin their treatment with medications such as methotrexate, leflunomide, sulfasalazine, or hydroxychloroquine, but eventually have their doctor suggest trying a more advanced treatment. These options include medications made from protein called biologics which are expensive to produce. Pharmaceutical companies making these expensive medications have developed patient support programs to help the public access these treatments.

When a physician orders a specialty medication, such as a biologic, the prescription is often sent to these support programs as a first step. A case manager will reach out to the patient to introduce themselves and find out what insurance coverage they may have. This could be through a government plan like Trillium or a private insurance plan through a person’s work. Insurance companies often require that an application be made to request coverage for expensive medications and these support programs can assist with these forms. Once the private insurance or government-based plan approves a treatment, there can sometimes still be a portion of the cost that is not covered. Support programs offer funding to cover this difference, so the patient is not spending out of pocket.

At Charlton Health, our team of reimbursement specialists work closely with all support programs to secure any extra funding that might be required. In some cases, these programs can even offer complimentary doses of your medication while you’re waiting for approval or switching from one insurance plan to another.

Patient support programs can also provide additional resources and support. This might include funding for certain blood tests, vaccines, educational materials, and resources on healthy living including counseling services.

Joyce Ayad is a 4th-year pharmacy student from the University of Waterloo who completed one of her rotations at Charlton Health. She believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. Joyce is eager to become a licensed pharmacist this year.