Income: 60 000 $
Her doctor informs her a new drug was recently approved by Health Canada in a new class of products called Biologics which may provide significant clinical improvements for her but it is not on the public formulary yet.
Jody visits her pharmacy to fill her prescription and is informed the drug is not yet on the approved list of medicine available on the provincial public drug plan. As a result Jody remains on her current medication. She continues to check in with her doctor every few months to see if the new drug has been approved, but her doctor is not aware of any change. On her subsequent visits to her local pharmacy, Jody asks for an update but is informed it’s still not on the public plan. It could take at least 12 more months (if approved) and will most likely come with conditions.
Jody visits her doctor for her annual physical and is informed the new product is now covered with conditions on the public drug plan for seniors. Her doctor completes the needed paperwork. After several weeks Jody finally has access to the medication, 18 months after it was approved and readily available in most private plans in Canada.