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Help with the medical test...IBD

Zoide

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Sep 15, 2014
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Did you apply in Canada? A kind user of this forum shared his story about procedural fairness with Crohn's disease (IBD). He was on Humira which I believe is similar to remicade (I could be wrong). He received procedural fairness letter but was able to overcome it. Please follow the link below:

http://www.canadavisa.com/canada-immigration-discussion-board/help-permanent-residency-possible-medical-inadmissibility-t175530.0.html;msg2761752#msg2761752

Did the doctor do any tests/checks related to your IBD?
Are you sure he was able to overcome it? He never posted again after saying he was worried about getting rejected: http://www.canadavisa.com/canada-immigration-discussion-board/members/dmeman.485795/#postings

Thanks
 

Zoide

Star Member
Sep 15, 2014
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Note that the Exceptional Access Program only applies to those who are eligible for Ontario Drug Benefit, a program for people that are disabled/low-income/welfare.
What about the Trillium Drug Program though?

"The Trillium Drug Program is for people who spend approximately 3 to 4% or more of their after-tax household income on prescription-drug costs.

To qualify for the TDP, you must:

  • not already qualify for Ontario Drug Benefit (e.g. you’re under 65 years old and not enrolled in a program such as Ontario Works)
  • have a valid Ontario health card"
And it gives you access to the Exceptional Access Program:

"To receive funding through the Ontario Drug Benefit (ODB) Program's Exceptional Access Program, the patient must be ODB-eligible, which includes Ontarians applying to the Trillium Drug Program (TDP)."

Or am I missing something? This sentence in the EAP page is confusing:

"Additionally, only ODB-eligible costs are considered for reimbursement. For example, drug costs over ODB -eligible costs, credit card and banking charges will not be reimbursed."

Thanks
 

ahmedhere

Star Member
Aug 10, 2016
109
9
Hello guys, here is my last update for this thread to be a complete blog for anyone who needs help with this issue at anytime :)...
I'm happy to say that I was able to successfully challenge the decision and convince them to invert it in a very short time period despite having a complicated case,
You can find the details of my case in the previous pages of this thread, and here is my advises/what I did to resolve the issue:
After speaking to a very famous lawyer (I paid 300$ just for that useless consultation session), it seemed my case is hopeless. He told me (if you get a letter from the pharma company stating 1-they are committed to give u the drug for free for 3 years, 2-they use your data on research so you are helpful to the society, 3-You are not taking the spot of a Canadian person in their support program, then you have a strong chance, but if you can't get that I'm afraid your chances are quite low)...
As you can imagine, it is impossible to get such a letter, as my specialist said (they would give you the drug compassionately even for a life time, but they would never give such a legal binding document)...
And to make things worse, that lawyer asked for 6500$ just to write a response letter for me!!
So of course I rejected and decided to work on my own...and here is my biggest advice:
-DO THE JOB ON YOUR OWN! There is no single case that doesn't have a weak point which you can exploit to attack the decision...the problem is that lawyers just have a few standard schemes that they wanna apply to every case...such as how that guy asked for a commitment letter...but if you work on your own case and give it enough time for research you can find special points in your special case that no lawyer will find...
Also to be honest being a PhD student and biologist helped a lot because I know a lot about drug research and industry...so I wrote the letter on my own...what did I write then? Will explain in the next reply...to keep things organized...
 
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ahmedhere

Star Member
Aug 10, 2016
109
9
So basically I wrote a 10 page response letter (yes 10 pages!!) including many points to attack the decision...while every case is different as I said above, I will tell you my main points just as an example...
1-Remicade is not Humira...basically I'm on remicade but the letter used Humira to calculate my costs...the officer did that because he mistakenly though it is a generic compound for Remicade as I will explain in the next point...
2-Remicade is a biologic drug, so it has biosimilars not generic versions....
Regular chemical drugs have generic compounds...means the exact same active ingredient produced in a different brand name by a different company, so those products are basically completely interchangeable. The problem in my case is that the officer (who is most like a general practitioner physician, not a specialist) used Humira to calculate rough costs of Remicade assuming it is a generic compound of remicade (both Remicade and Humira have the same active compound infliximab)...
But that's wrong! remicade is a biologic drug, which means it is produced in live cells...its exact structure and the mechanism by which it works is not fully characterized, thus you can never make a generic compound for a biologic drug...but you can make a biosimilar, and humira is one of remicade's biosimilars. As the name states, biosimilars are expected to work similarly, but not guaranteed to have exact same effect in every patient, in fact the FDA and Health Canada announced that they don't encourage interchangeability of biosimilars. So, there is no logical grounds to use the cost of Humira in stead of Remicade.
But I was still wondering, why did the officer do that? Actually Remicade is much more expensive, so why did he not use remicade in cost calculation and used Humira? the answer is because Humira is supported by canadian public health insurance, while remicade is not supported for new applicants, only for current benefit holders!
So to sum up, my main defence was that I'm on Remicade not Humira, and you can not assume that I can automatically shift to Humira since it is a biosimilar not generic, so not guaranteed to work. Since I never took remicade on governmental support, I will never be eligible for that support and so I can never cost the health system.
Just to highlight why it is so important to do the job on your own, when I told that lawyer the different drug issue his reply was (well you are lucky they used Humira, cause Remicade is even more expensive, so better not remind them!)...luckily I ignored his advice and was able to do my research and know these details...
That was my main defense point, I also added a couple of points asking for a compassionate consideration of my application (again the lawyer mentioned above advised me not to do so unless I can show documents, but I still did) stating I am a researcher in Canada who authored many research papers during my study in Canada so I added and still add to the society. Also because I'm from a less advanced country where health system is not well established, so my disease may progress if I leave Canada, and luckily I found some news reports about a case where the federal court of Canada granted a stateless person from Kuwait asylum and PR in Canada a few years ago because he had Crohn's disease and made the claim that he can't get enough health care support in Kuwait. So I said, while I'm from a different country, my case is quite similar in terms of drug and financial support availability.
I also filled a declaration form that I will pay for my treatment if required, but I'm pretty sure they didn't consider it cause I didn't provide any real plan or document saying I can afford the costs.
That's it, then I sent it to a friend who is an IPR lawyer to read it over and make sure of the formality and so on since he can't judge the content because he is not an immigration lawyer and doesn't know much about it.
Of course I added a governmental website as a reference to support each claim I made, 90% of my references where from healthcanada or FDA websites.

I honestly expected it will take at least 3 months till they reply, and believed my chances are not more than 10%...cause I didn't really provide that letter the lawyer told me about, and didn't add any new documents. Surprisingly, in 2 weeks they changed my status to "Passed the medical exam" and now they require me to send them my passport to be granted the PR confirmation.
I think this is the fastest case of this kind I hear about, never expected it will settle before at least a few more months. Again, my advice is to do the job on your own, do a lot of research and plan your response. Search for points that make the calculation mentioned your fairness letter wrong ot even uncertain.

Finally I would like to thank Mr Computergeek on this forum, he helped put my feet on the beginning of the route and his advises were very precious.
 
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edwinkhoi

Full Member
May 19, 2017
46
18
So basically I wrote a 10 page response letter (yes 10 pages!!) including many points to attack the decision...while every case is different as I said above, I will tell you my main points just as an example...
1-Remicade is not Humira...basically I'm on remicade but the letter used Humira to calculate my costs...the officer did that because of a reason you will know about in the next point...
2-Remicade is a biologic drug, so it has biosimilars not generic versions....
Regular chemical drugs have generic compounds...means the exact same active ingredient produced in a different brand name by a different company, so those products are basically completely interchangeable. The problem is that in my case the officer (who is most like a general practitioner doctor, not specialized) used Humira to calculate rough costs of Remicade assuming it is a generic compound of remicade (both Remicade and Humira have the same active compound infliximab)...
But that's wrong! remicade is a biologic drug, which means it is produced in live cells...its exact structure and the mechanism by which it works is not fully characterized, thus you can never make a generic compound for a biologic drug...but you can make a biosimilar, and humira is one of remicade's biosimilars. As the name states, biosimilars are expected to work similarly, but not guaranteed to have exact same effect in every patient, in fact the FDA and Health Canada announced that they don't encourage interchangeability of biosimilars. So, there is no logical grounds to use the cost of Humira in stead of Remicade.
But I was still wondering, why did the officer do that? Actually Remicade is much more expensive, so why did he not use remicade in cost calculation and used Humira? the answer is because Humira is supported by canadian health insurance, while remicade is not supported for new applicants, only for current benefit holders!
So to sum up, my main defence was that I'm on Remicade not Humira, and you can not assume that I can shift on Humira because it is a biosimilar not generic, so not guaranteed to work. Since I never took remicade on governmental support, I will never be eligible for it and so I can never cost the health system.
Just to highlight why it is so important to do the job on your own, the lawyer I consulted told me about the brand name issue (well you are lucky they used Humira, cause Remicade is even more expensive, so better not remind them!)...luckily I ignored his advice and was able to do my research and know these details...
That was my main defense point, I also added a couple of points asking for a compassionate consideration of my application (again the lawyer mentioned above advised me not to do so unless I can show documents, but I still did) stating I am a researcher in Canada who authored many research papers during my study in Canada so I added and still add to the society. Also because I'm from a less advanced country where health system is not well established, so my disease may progress if I leave Canada, and luckily I found a some news reports about a case where the federal court of Canada granted a stateless person from Kuwait asylum and PR in Canada a few years ago because he had Crohn's disease and made the claim that he can't get enough health care support in Kuwait. So I said, while I'm from a different country, my case is quite similar in terms of drug and financial support availability.
I also filled a declaration form that I will pay for my treatment, but I'm pretty sure they didn't consider it cause I didn't provide any real plan or document saying I can afford the costs.
That's it, then I sent it to a friend who is an IPR lawyer to read it over and make sure of the formality and so on since he can't judge the content because he is not an immigration lawyer and doesn't know much about it.
Of course I added a governmental website as a reference to support each claim I made, 90% of my references where from healthcanada or FDA websites.

I honestly expected it will take at least 3 months till they reply, and believed my chances are not more than 10%...cause I didn't really provide that letter the lawyer told me about, and didn't add any new documents. Surprisingly, in 2 weeks they changed my status to "Passed the medical exam" and now they require me to send them my passport to be granted the PR confirmation.
I think this is the fastest case of this kind I hear about, never expected it will settle before at least a few more months. Again, my advice is to do the job on your own, do a lot of research and plan your response. Search for points that make the calculation mentioned your fairness letter wrong ot even unsure.

Finally I would like to thank Mr Computergeek on this forum, he helped put my foot on the beginning of the route.

That is AMAZING, AMAZING to hear Ahmedhere!! Congratulations on successfully challenging the medical decision. It is also really thoughtful of you to write this follow up posts so anyone in a similar situation can refer to them in the future. And 2 weeks time is almost unbelievable. I am really happy for you.

I myself have a medical condition and I was so worried that I would receive a fairness letter. Very luckily for me I passed the medical exam (knock on wood because I fear my medical status may change). I agree with you that we are the experts of our own problems. With research and careful planning, we can indeed overcome most obstacles in life.

Once again, thanks for sharing your experience with us and good luck with your new life as a Canadian PR!

Cheers,
 

ahmedhere

Star Member
Aug 10, 2016
109
9
That is AMAZING, AMAZING to hear Ahmedhere!! Congratulations on successfully challenging the medical decision. It is also really thoughtful of you to write this follow up posts so anyone in a similar situation can refer to them in the future. And 2 weeks time is almost unbelievable. I am really happy for you.

I myself have a medical condition and I was so worried that I would receive a fairness letter. Very luckily for me I passed the medical exam (knock on wood because I fear my medical status may change). I agree with you that we are the experts of our own problems. With research and careful planning, we can indeed overcome most obstacles in life.

Once again, thanks for sharing your experience with us and good luck with your new life as a Canadian PR!

Cheers,
Thanks a lot man, and don't worry they can't change your medical status after it is already "passed" lol...so rest assured it is fine :)
 

DEEPCUR

Champion Member
Apr 12, 2016
2,428
642
Good luck Ahmed! Thanks for posting your experience and success here!

Also. don't forget to poke that lawyer back and mention about succeeding on your own!
 
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darkmater

Star Member
Mar 19, 2016
114
20
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Yes, I am taking Humira for my RA and passed my medicals last month. PR still to come, hopefully. I declared my disease and all the medications I take. Got a report from my specialist and submitted it too. I didn't use a lawyer. All the best !!
I had ulcerative colitis diagnosed back in 2002, I have been in remission for over 15 years and used only mesalazine 3x500mg per a day. I was nominated and will be going to medical exam soon. I was wondering about your medical exam process, how was it? Were you asked to take colonoscopy or something else? What kind of documents did you submit to CIC? if Could you share your experiences I would be glad. Thank you.
 

darkmater

Star Member
Mar 19, 2016
114
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I had ulcerative colitis diagnosed back in 2002, I have been in remission for over 15 years and used only mesalazine 3x500mg per a day. I was nominated and will be going to medical exam soon. I was wondering about your medical exam process, how was it? Were you asked to take colonoscopy or something else? What kind of documents did you submit to CIC? if Could you share your experiences I would be glad. Thank you.
Guys I am stil waiting for replies from seniors. Btw, in case you have a health issue and asked for a medical report what this medical report provided by your own specialist should include?
Thnx
 

ahmedhere

Star Member
Aug 10, 2016
109
9
Guys I am stil waiting for replies from seniors. Btw, in case you have a health issue and asked for a medical report what this medical report provided by your own specialist should include?
Thnx
It depends on your case, if they need a furtherance letter they would clearly tell you what information they need...
I honestly think you don't have anything to worry about at all...Mesalamine and its generic compounds are very cheap, ways under the health care requirements for average Canadian (about 6500 CAD/year)...
In case of Remicade or humira we are speaking about 10-50 thousands of dollars per year, completely different
 

darkmater

Star Member
Mar 19, 2016
114
20
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It depends on your case, if they need a furtherance letter they would clearly tell you what information they need...
I honestly think you don't have anything to worry about at all...Mesalamine and its generic compounds are very cheap, ways under the health care requirements for average Canadian (about 6500 CAD/year)...
In case of Remicade or humira we are speaking about 10-50 thousands of dollars per year, completely different
I see dear ahmedhere. Were you asked to take colonoscopy or something else? What kind of documents did you submit to CIC?
 

darkmater

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Mar 19, 2016
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No, they just asked for a case report from my specialist stating my current infusion dosage and frequency
Thank you dear. To be sure of it, what is exactly a "case report" (what does it contain?), and did you get this case report from your own specialist or from the designated specialist of CIC?
Thanks a lot, your experience is precious to me brother.
 

ahmedhere

Star Member
Aug 10, 2016
109
9
Thank you dear. To be sure of it, what is exactly a "case report" (what does it contain?), and did you get this case report from your own specialist or from the designated specialist of CIC?
Thanks a lot, your experience is precious to me brother.
The doctor knows what to write in it, as I told you man, they will tell you what exact information they need, so just don't worry about it, wait and see.