Help with medical inadmissibility for PR application, Remicade

[SaiLL7mj]

I would like to ask questions about medical inadmissibility related the cost of remicade.

I am applying for PR, however, the big cost (over 35000$/year) of remicade is a big issue. However, there is a slight chance here: the public drug plan (quebec) does not include remicade anymore. Instead, they only cover a cheaper biosimilar Infectra which costs around 18000-25000/year which falls in the threshold of the temporary medical inadmissibility act. However, there are exceptions for the remicade coverage: for example, RAMQ (quebec) says:

RemicadeTM remains payable to persons in the course of treatment who have received a refund from
Régie or an insurer or by the administrator of the benefits plan before February 15, 2017 and who
comply with the instructions giving right to payment.

In my case, I have been in the treatment since 2012 and never was using public drug plan. I was using the compassionate dose from the pharmaceutical company before Feb, 2017. My question is: Am I eligible for this exemption? I hope not, because then they will only cover the price of Infectra which is more hopeful to get approved from the medical officer.

My second question is: I applied my PR in the beginning of this year and the new temporary act about the new threshold (19900$) is effective in June. So, am I still eligible for this new threshold?

I know there are examples in this forum, some remicade users successfully defended their case, so I expect more helpful answers from you guys.
Big thanks!

 

[zardoz]

I would like to ask questions about medical inadmissibility related the cost of remicade.

I am applying for PR, however, the big cost (over 35000$/year) of remicade is a big issue. However, there is a slight chance here: the public drug plan (quebec) does not include remicade anymore. Instead, they only cover a cheaper biosimilar Infectra which costs around 18000-25000/year which falls in the threshold of the temporary medical inadmissibility act. However, there are exceptions for the remicade coverage: for example, RAMQ (quebec) says:

RemicadeTM remains payable to persons in the course of treatment who have received a refund from
Régie or an insurer or by the administrator of the benefits plan before February 15, 2017 and who
comply with the instructions giving right to payment.

In my case, I have been in the treatment since 2012 and never was using public drug plan. I was using the compassionate dose from the pharmaceutical company before Feb, 2017. My question is: Am I eligible for this exemption? I hope not, because then they will only cover the price of Infectra which is more hopeful to get approved from the medical officer.

My second question is: I applied my PR in the beginning of this year and the new temporary act about the new threshold (19900$) is effective in June. So, am I still eligible for this new threshold?

I know there are examples in this forum, some remicade users successfully defended their case, so I expect more helpful answers from you guys.
Big thanks!

IMHO, this is not a D-I-Y scenario and you would be best served by working with a competent immigration lawyer, who has had experience in this very specialized area of inadmissibility.

 

[canuck78]

Yes you qualify for the new limit but you would still exceed it. Even at the lowest dose you have to add any doctors visits, tests, etc Compassionate use can end so the province would then have to cover the cost of your treatment. You need to hire a good lawyer.

 

[SaiLL7mj]

Yes you qualify for the new limit but you would still exceed it. Even at the lowest dose you have to add any doctors visits, tests, etc Compassionate use can end so the province would then have to cover the cost of your treatment. You need to hire a good lawyer.

Thanks for the nice reply. My wonder is about the new rule of the Quebec public drug plan: they will only cover this medication if you are already reimbursed from an insurer before Feb 2017. In my case, I was using compassionate drug, which arguably means they cann't approve my coverage when I have to switch to Public drug plan someday. If this is real, then it means whatever, the public plan will only cover the price of the biosimilar which is 45% cheaper. But I have very limited and unsure information now.

 

[canuck78]

Thanks for the nice reply. My wonder is about the new rule of the Quebec public drug plan: they will only cover this medication if you are already reimbursed from an insurer before Feb 2017. In my case, I was using compassionate drug, which arguably means they cann't approve my coverage when I have to switch to Public drug plan someday. If this is real, then it means whatever, the public plan will only cover the price of the biosimilar which is 45% cheaper. But I have very limited and unsure information now.

Nobody on this forum will know the answer.

 

[SaiLL7mj]

Nobody on this forum will know the answer.

Thanks, I think you are right and I will repost it in skilled worker immigration section

 

[canuck78]

Thanks, I think you are right and I will repost it in skilled worker immigration section

Nobody on the whole forum will be able to answer. This is why you need a lawyer for your complicated case.

 

[SaiLL7mj]

Nobody on the whole forum will be able to answer. This is why you need a lawyer for your complicated case.

actually there are several people in this forum with the same medical issue, a few successed. Their conclusion is to collect the information by yourself and communicate with your own doctors as lawyers can only help with the format of the explanation letter.

 

[canuck78]

actually there are several people in this forum with the same medical issue, a few successed. Their conclusion is to collect the information by yourself and communicate with your own doctors as lawyers can only help with the format of the explanation letter.

Yes but you were asking about a very specific case about Remicade a Quebec.

 

[SaiLL7mj]

Yes but you were asking about a very specific case about Remicade a Quebec.

yes, because i think they may calculate the expense based on the specific province

 

[canuck78]

yes, because i think they may calculate the expense based on the specific province

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/I am just saying your situation is quite individual with Quebec not covering, you having use compassionate use from the drug company, etc. You would be better served at this point by a lawyer who has experience with medical inadmissibility not the forum.