My Asthma Is So Pricey That I Can’t Afford It: Living with Asthma in Canada

Healthcare

Asthma belongs to the chronic diseases that require a regular intake of medications throughout the lifetime, which makes it a condition that not only worsens the quality of life but also requires a lot of money. Managing your asthma wisely means considering both your health issues and your expenses.

Currently, there is no cure for asthma. If you are diagnosed with that lifelong disease, you need to learn how to live with it, avoiding asthma triggers, and which medications to take to deal with asthma safely. If neglected, asthma can deteriorate and cause reduced physical activity and the ability to work. Asthma is not considered a terminal disease, but if it’s left uncontrolled, there is a certain risk of a fatal asthma attack that may cause death. The survey undertaken by The Lung Association in 2016 had revealed that 90% of Canadians with asthma do not control it properly. What is the matter with Canadians? Why do they so childishly careless?

Why Canadians don’t manage their asthma properly

Canadians would control their asthma as it’s recommended if they have had proper coverage of all the asthma medications. The truth is that most provincial plans do not cover prescription medications prescribed on the in-patient basis for general categories of the population. A number of provinces have special plans for “catastrophic” drug coverage (Ontario, British Columbia, Saskatchewan, Manitoba, Nova Scotia, Newfoundland and Labrador, and Prince Edward Island). The amount of “catastrophic” expenses that are subject for coverage varies significantly in different provinces (from 1.3%-3.2% of net family income in British Colombia to 3%, 5%, 8% or 12% of net family income on Prince Edward Island). Mostly, those programs cover all the expenses over the stated amount.
All provinces have plans for the elderly (65+), whereas Ontario recently (in 2018) implemented a new program OHIP+ for children and youth (under 25) that covers 4,400 prescription drugs.

At the same time, despite optimistic reports of provincial health care authorities, people continue claiming that the burden of their out-of-pocket expenses is too heavy for them. Here you can find some excerpts from patients’ letters published on the Asthma Canada (asthma.ca) website: “Thus, even though I am paying for two drug plans, I still have to pay $286 for a three-month supply of Singulair.” (A patient from Winnipeg, MB)
“One puffer*, upfront, would have cost me $200. Multiply that by 3, add my nasal spray, prescription allergy pills, and my asthma controller pills, I would have been out close to $1000.” (A patient from Richmond Hill, ON)
*puffer=inhaler

“I have severe eosinophilic asthma, which is a rare form and yet there are multiple medications offered and I can’t access since it’s not funded and my insurance is not high enough to cover it.” (A patient from Langley, BC)

How is it possible? The point is that proper asthma management includes at least two kinds of medications used on a permanent basis and at least one emergency medicine to stop an asthma attack in progress. Most of those medications are expensive and not all of them covered. Let’s have a closer look at the medicines one needs to live with asthma.

Medications that are used to control asthma

Normally, people with asthma have to take both long-term and quick-action drugs to minimize the number of asthma attacks and reduce the symptoms of the disease.

Long-term preventive medications

This group includes:

  1. Corticosteroids

Corticosteroids used to control asthma comprise ICS (inhaled corticosteroids) and oral corticosteroids.
ICSs are the most common long-term asthma controllers that are normally taken twice a day on the permanent base for years. The most common inhaled corticosteroids are:

  • Fluticasone,
  • Beclomethasone,
  • Budesonide,

ICSs reduce swelling and mucus production in the airways. ICSs are considered among the safest asthma-controlling drugs with fewer side effects.
Oral corticosteroids, as a rule, are prescribed with short courses (for about 2 weeks) for those patients who have severe worsening of the disease and an increased number of asthma attacks. Taking corticosteroids such as prednisone or methylprednisolone stabilizes the condition after which the patient should switch to his normal medication regimen. Long-term use of oral corticosteroids is not recommended as they have severe system side effects, such as weight gain, high sugar levels, osteoporosis, and others.

  1. Long-acting beta agonists

Long-acting beta agonists (LABAs) work by relaxing smooth muscles in the airways. They are not intended for monotherapy and always used in long-term treatment together with ICSs. The most frequently used LABAs:

  • Salmeterol,

There also some combination medicines containing the ICS and LABA together, e.g. Advair® (Fluticasone/Salmeterol), and Dulera® (Mometasone/formoterol).
These two types of asthma controllers are the most common therapies. Another two groups are mostly used in limited categories of people who do not respond to traditional medications or have severe adverse reactions.

  1. Leukotriene modifiers

Leukotriene modifiers may be used for long-term therapy of moderate and severe asthma as an alternative treatment if other medications were not effective or as medicines additional to ICSs instead of LABAs. The most known drug of this group is Singulair that is an oral medication. Although Leukotriene modifiers are considered less effective than ICS, those who respond to the therapy positively find Singulair more convenient. The bad news for those who use Singulair is that it is not covered by government-funded insurance plans.

  1. Immunomodulators

Immunomodulators are mostly used in people with asthma of allergic origin who do not respond to inhaled steroids or LABAs. Immunomodulators are also very expensive drugs and not covered, so they are mostly recommended only if there are strict indications for use.

Quick-relief asthma drugs

Short-acting bronchodilators are used to stop an asthma attack. These medicines are used to relax muscles and open contracted airways. The most common bronchodilators are short-acting beta-antagonists, such as Albuterol, Levalbuterol, Metaproterenol, and others. Comparing the price of these medications bought off a local pharmacy chain to that quoted by online retailers of drugs one can see the obvious advantages of ordering asthma solutions online. Also, the assortment of asthma drugs is often quite more impressive with Webshops. My Canadian Pharmacy is consistently referred to as online support to people with asthma condition on many levels: informational, material, consultation, and the wide range of drugs available there is another point in favor of going from physical to virtual shopping in the face of pending reforms.

The annual cost of asthma in Canada

For calculation, we used average prices for generic medications in Canadian community pharmacies.

* Specified in a cell if different. ** The dosage and course duration may vary significantly for different people. Although corticosteroids are not recommended for long-term use due to their system side effects, sometimes they can be prescribed on the long term basis if needed.
As you can see, the cost of different types of asthma medications may differ by one order of magnitude. This comparison is not completely adequate, as dosages may vary significantly depending on disease degree and individual features of a patient. So, treatment plans can be absolutely different and the costs as well. According to the official statistics, asthma medications for an individual can cost from $200 to $4,500-5000 annually. An expensive treatment with Xolair, as a rule, is not covered and rarely prescribed, not only because of a high cost of treatment but also as it is indicated only for specific types of allergy-induced asthma.

How to save on my asthma plan?

Taking into consideration the diversity of medications and differences in individual conditions, the number of asthma plans can be almost unending. When you talk to your doctor you should ask him to mind not only medical but also a financial issue. The most expensive drug is not necessarily the most effective personally for you. Here you can find some recommendations how to manage your asthma expenses better.

  1. If you are eligible for any coverage for asthma medications, please ask your doctor to prescribe those medications that are covered.
  2. If the doctor consider that you may benefit from the medicine that is not cover, investigate if you have any possibility to get coverage, for example, by changing your plan or applying for specific social programs.
  3. If you have to pay out-of-pocket ask your doctor to prescribe cheaper options if they are interchangeable.
  4. Consider generics. All government insurance plans in Canada covered with generic drugs unless there is no generic alternative yet. It’s a myth that the brand medicine more effective: it’s just more expensive.
  5. Buy medications in larger packages. The packaging costs a lot and you pay for it over and over again. When you buy an inhaler, you, probably, pay more for a device than for the medicine it contains. If you buy a puffer with a greater number of doses, you reduce the cost of one dose.
  6. If you don’t have insurance or your plan doesn’t cover all your medication, buy online. Although our government does a good job negotiating and reducing costs of medications to cover insurances, online pharmacies are still cheaper. There is much buzz about counterfeit medication sold online, but all that you need to get rid of troubles is to find a trusted drugstore. There are at least a few dozen of reputable online pharmacies in Canada that deliver quality drugs at more than reasonable prices.