Approved treatments (treatments listed on the Drug Formulary) can be prescribed by your doctor and are available through most drug stores and hospitals. Provincial or territorial health insurance pays many of your medical costs. But it does not always pay for prescription treatments. Depending on what province or territory you live in, you may get a “drug card if you receive social assistance (welfare, and so on.). Some people may qualify for a drug card without collecting social assistance. If you present your drug card to your pharmacist, he or she can get the government to pay for most approved treatments. If your province or territory does not issue a drug card, your doctor may be able to make arrangements with a pharmacy or hospital to have treatments provided to you free of charge. If you’re working and have a private insurance plan, you may be paid back for the cost of your treatments. If you’re working but do not have private insurance, you’ll probably have to pay for treatments yourself. Some people get treatments without having to pay, through HIV clinics or treatment centres which are part of larger hospitals. A few AIDS groups have emergency funds to help people pay for medication.
Private Insurance Coverage
If you have a job, or are on long-term disability benefits from work, you may have a health coverage plan that includes drug treatment and other benefits. The insurance company will pay for all or part of the cost of treatments prescribed by a doctor for you. Usually the list of treatments that private insurance companies cover is very similar to the provincial or territorial government Drug Formulary. Some insurance companies will not pay for some treatments, such as vitamin B12 (considered a treatment therapy for preventing malnutrition) for people with HIV, because they do not see them as drug treatments. Most complementary therapies are either not covered or only partly covered by private insurance. If you’re new to a job, you may not be able to get private medical insurance because of your HIV status. If you do have private insurance through work, this may be a factor in deciding whether or not to leave your job.
Off-label use of drugs
The term “off-label use of drugs” refers to any use of a drug for which the drug has not been formally tested or approved. Often a private insurance company will not cover the costs of off-label drug use. You should speak to your doctor about this, he or she may be able to find a way to get the insurance company or the provincial or territorial government to cover the cost.
Paying for yourself treatments
If you’re not on social assistance and are not a status Indian, and you have no private insurance - or if the treatment you want is not on the government or the OTC formulary list - you may have to pay for treatments yourself. If your job does not provide any insurance, you must either pay for your medication (which can come to several hundred dollars a month or more), or do without. If you can not afford to buy the medication you need, call your nearest AIDS group to find out about other options that may be available. The group may provide vitamins, supplements, and / or emergency funds, or may be able to find other ways of getting your medications covered.
HIV clinics
Certain treatments which have been approved for use by people who have HIV or AIDS, but which are still being tested, are distributed-province or territory-wide through HIV clinics or centres to other hospitals and clinics. You must have a prescription for these treatments and pick them up at a hospital pharmacy or special clinic, since they are not regularly available at drug stores. If you live in a rural area and travel to a city hospital in order to get a treatment, you may be able to arrange for a hospital closer to you to give it to you. You or your doctor can call an HIV clinic and tell them who you are and what you want the hospital shipped to treatment.