From $17,000 to $0: Smiths Falls area patient with cancer shares tips to avoid paying medication out-of-pocket

·3 min read

Not only did Leo Valiquette, 51, have to deal with the stressful news in Feb. 2020 that he had cancer, he was also facing potential out-of-pocket costs of $17,000 per month for targeted gene therapy.

“My initial thought was, do I have to mortgage my house? Do crowdfunding? Twelve months of treatment is over $200,000 … (I) don’t have private health care to cover costs,” said Valiquette, a former Ottawa-area journalist.

He discovered a lump under his left arm on Dec. 2019, and after “not feeling great for a month,” had a consultation with his doctor. After a biopsy was performed, it was determined that he had metastatic melanoma, a type of skin cancer.

A cancer diagnosis for an Ontario resident has a significantly higher price tag and out-of-pocket expenses than residents of other provinces such as British Columbia or Alberta.

“In British Columbia or Alberta, (if you were) prescribed take-home cancer medications, it would be 100 per cent covered. In Ontario, it’s not,” said Stephen Piazza, manager of advocacy for the Canadian Cancer Society (CCS).

There’s a double standard system in Ontario that needs to be addressed, according to Valiquette. “If you’re totally covered under OHIP for treatment in a hospital setting, but not covered if it’s in a plastic pill bottle at home, why is that?”

He advocates for change and added that “we should be glad that people can manage their condition, recover (at home) and don’t have to be in the hospital.”

Currently a self-employed marketing consultant who lives near Smiths Falls, Valiquette also considered undergoing immunotherapy treatment (mainly because it was covered by OHIP), even though his oncologist said gene therapy would be the best treatment for his type of cancer.

It was after Valiquette reached out to the cancer centre that he found out he had options.

“I only knew vaguely about the Trillium Drug Program — I thought it was for seniors. Turns out anyone can be covered as long as it’s four per cent of your (after-tax) household income,” he explained.

Some of the qualifications for the Trillium Drug Program include not being enrolled in Ontario Works or the Ontario Drug Benefit program and not having an insurance plan that pays 100 per cent of prescriptions, according to the website.

Valiquette also found out the medications he needed — Mekinist and Tafinlar — could be covered by the drug manufacturer. “The drug maker (Novartis) that pioneered and produced these drugs has a program you can apply to and have the deductible covered.”

With Trillium’s drug plan and Novartis’ help, Valiquette ended up paying nothing for his 12-month targeted gene therapy, which ends May 15.

“Every cent of the $17,000 monthly drug cost is covered. Other people would definitely have different stories than mine,” Valiquette said.

Some side effects of his medication include fever and “brain fog”. He had lymphedema — swelling of his left arm--from surgeries to remove his lymph nodes. He said he feels grateful that he remains functional during the treatment.

“In my case I’ve gotten off relatively easy, and I’ve continued to work and make a living,” he said.

Taking the time to see what’s available, researching options and asking questions are some of the advice Valiquette gave to people diagnosed with cancer, when faced with expensive, new or experimental at-home medications.

“There are different options depending on your cancer diagnosis,” he said.

Valiquette cautioned that “if you see something not right or abnormal, get it looked at right away. Cancer is a chameleon: it comes in many sizes and forms.”

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Yona Harvey, Local Journalism Initiative Reporter, Smiths Falls Record News