Coverage Tips

Positive Airway Pressure Systems (Benefit Tips ® - © 2014)

Overview

People who have breathing problems, such as sleep apnea can be treated with positive airway pressure (PAP) devices that use mild air pressure to keep an airway open.

Products

The most common PAP device is a Continuous Positive Airway Pressure (CPAP) that blows air at a constant set pressure to keep the air passages open.
A BiLevel Positive Airway Pressure (BiPAP) device blows air at two distinct pressures: one at inhalation and another at exhalation.
An Automatic/Auto-Titrating Positive Airway Pressure (APAP) device blows air at a range of pressures, constantly adjusting to the minimum pressure needed to keep airways open. The breath-by-breath adjustments maximize comfort by minimizing pressure.

Process

A prescription from a doctor is required to obtain or change the pressure settings on a PAP device. Based on symptoms, a physician may refer a patient to a sleep clinic for a sleep study in order to diagnose obstructive sleep apnea (OSA). Once diagnosed with OSA, the patient will receive a prescription for the most appropriate PAP device and pressure setting(s).

Cost

The cost of PAP devices vary widely base on the type of device (CPAP/ BiPAP/ APAP), manufacturer, model and distribution channel (boutique/chain/online). Another complicating factor is that some provinces set a maximum price for each type of device which may influence both price and supply.
The cost of replacement parts and upgrade options such masks and hoses vary widely with the distribution channel (boutique/chain/online).
Some provincial medical insurance plans cover a significant portion of the cost of a PAP device.
Most health insurance policies cover the cost of PAP device and replacement parts such as masks and hoses.

 

Medical Cannabis (Benefit Tips ® - © 2014)

Overview

The buds of the cannabis sativa and cannabis indica plants contain cannabinoids and terpenes that when ingested or inhaled are purported to have physiological effects on appetite, nausea, pain, inflammation, seizures, spasticity as well as psychoactive effects. The medicinal use of cannabis dates back to 2,700 B.C in China. Cannabis may also be referred to as marijuana, marihuana, weed, grass, pot, Mary Jane, etc.

Medication Cost

The approximate cost of medical cannabis ranges from $250 to $750 monthly based on a typical prescribing range of 1-3 grams daily with a typical cost of $7.50 including sales tax and delivery.

Coverage

Medical cannabis is not covered by most health insurance plans since it is not specifically listed as a covered expense and cannot be considered a prescription drug because the physician completes a “medical document” rather than a “prescription” and the medication is dispensed by a “licenced producer” rather than a “pharmacist”.

Health spending accounts may cover medical cannabis since it appears to be an eligible medical expense for income tax purposes. The Canada Revenue Agency identifies medical marijuana as an eligible medical expense but references the Marihuana Medical Access Regulations (MMAR) which was repealed on March 31, 2014. It is expected that their reference will be updated to reflect the current legislation which is the Marihuana for Medical Purposes Regulations (MMPR).

Process

Since April 2014, physicians have been able to authorize medical cannabis as therapy for their patients. Some doctors and clinics specialize in cannabis therapy and are equipped to provide the patient education and monitoring that is required. When a patient qualifies for cannabis therapy, the physician will complete a medical document specifying the recommended dosage and duration of authorization. Next, the patient completes the Licenced Producer's registration form and can place an order once the producer verifies the medical document with the physician. Medical cannabis will be delivered to the patient and may not be picked up from the Licenced Producer.

Medical Equipment

While Health Canada has issued a medical device licence for the Volcano Medic to vaporize cannabinoids, the Canada Revenue Agency does not consider a vaporizer to be an eligible medical expense. Therefore, the cost of a vaporizer may not be covered by health insurance or a health spending account.