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Old 01-25-2016, 05:14 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,917,951 times
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Quote:
Originally Posted by funisart View Post
My plan has Premarin. But it is very expensive. So I changed to what my doctor takes herself. No problems --now all hrt's com with high risk warnings for those over 65. The Dr does have to do some paperwork saying it is medically necessary.
I did run across one plan that covered Premarin (with high co-pays) when I was comparing Part D plans in my area during the open enrollment period but it was like $90/month (I'm paying about $25/month now). Bottom line was the plan didn't make "dollars and cents/sense".

What are you taking now?

I am not sure that those of us who have had hysterectomies/BSOs - no plumbing left - are at high risk with something like Premarin. Unless we have (significant) family histories of breast cancer. I've been on Premarin for 30+ years now - since a hysterectomy/BSO. Can't say it helps with anything in particular. But it doesn't seem to hurt either. Any "reviews" would be appreciated,

My GYN recently prescribed a topical vaginal Rx for me - to deal with "thin skin". The yucky gooey cream (Premarin) is covered by my Medicare Part D plan (class 3 drug) - but the tidier pill - called Vagifem - isn't covered at all (and it costs like $300/month for 8 pills). I am not sure what I'll wind up doing. But if I wind up with any of these more expensive drugs not covered under my Medicare Part D plan - I'll be buying them through a Canadian pharmacy (not totally cheap - but cheaper). Robyn
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Old 01-25-2016, 05:49 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,917,951 times
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Quote:
Originally Posted by canadian citizen View Post
Robyn.

You asked some very insightful questions, about how Ontario deals with seniors who need to have expensive drug therapy. Here is a link to the Ontario Ministry of Health website about that subject. I think that it will answer many of your questions.

link. The Ontario Drug Benefit (ODB) Program - ODB for seniors- ODB if you live in a Long-Term Care homePublic Information - MOHLTC

Note the line about what happens when a person in Ontario reaches age 65. That is a huge difference between our system, and the US.

A few points about how health care works in Canada.....

It is Universal, which means that everyone who is either a Canadian citizen, or a legal Permanent Resident in Canada is covered. There are no restrictions about age, race, income or a lack of it or "pre-existing conditions " . You cannot be denied service. No one can be "cut off ". We ALL PAY FOR IT through our incomes taxes, and when we buy things that have a sales tax on them. Even people who are "low income " help when they buy things that have a sales tax on them.

Each of the 10 Provinces and 3 Territories operate their own system, under the general guidelines et out in the Canada Health Act , which is Federal legislation. Canadians may, if they choose to do so, buy private extended health insurance, that covers things that the Provincial program doesn't cover, like dental, eyeglasses, and chiropractic. My wife is a retired employee of the University of Toronto, and as a part of her pension benefits, she has a wide ranging coverage from Greenshield, for a fixed cost of $ 90 a month, for the rest of her life. As her spouse I am also covered in that plan.

I was born in Canada, and I in all my years here, I have never , ever been given a bill for hospital services. I have paid for a rental TV in my room, and before I had a cell phone, I paid for a phone in my hospital room. Because we have a single payer system ( which is the Provincial or Territorial Government ) we never see a bill, for hospital, laboratory, Doctor services, and or other required medical service. Obviously, a MD in Canada doesn't need to have a collection clerk, as they are paid by the Provincial Ministry of Heath, 60 days after they submit their monthly billing, by electronic means. They are also paid by electronic payment, too. Did I mention that mal practice insurance in Canada is about on tenth of what it costs in the USA ? Why ? Simple, if you sue some on in Canada, and you loose, YOU pay your costs, plus theirs, as well. That keeps the stupid stuff out of the court system.

In June of last year, my wife rolled our car in a rainstorm on the highway, when a car cut her off. She was seriously hurt ( fractured sternum, ribs, and neck cuts from the seat belt ). She took out one of those roadside information signs, as she went into the ditch. She spent 4 days in the hospital, the car was a write off and the sign cost about $3500 to replace. Our cost ? Zero.

The auto insurance paid for the towing, and the replacement of the information sign, they made a cash offer us to replace the 4 year old car, the EMS crew was covered by the OHIP benefits, the medical care at the Milton hospital was great, and covered by OHIP. The auto insurance policy, as required by law in Ontario, provided complete physio therapy, which is continuing to this day, and also provided a weekly house cleaner for six months. Brenda is also still getting weekly massage therapy, paid by our automotive insurance coverage. Did our car insurance policy increase ? Not at all.

If you were to suggest that any Canadian political party was going to do away with the health care coverage that we all enjoy here....it would be political suicide for them. Our system is NOT perfect, but it is certainly miles ahead of the mess that US citizens have to put up with.

Because we all contribute to the funding of our system, we know that it is going to be there when we need it.

Jim B.
Our system isn't perfect. Yours isn't either. Since my husband was diagnosed with MS 30+ years ago - I follow what is going on with MS drugs (which are 5 or 6 of the most expensive drugs out there for relatively common conditions). In places with semi-socialized health care systems - like Canada - you have to jump through a bunch of hoops to get the latest and greatest - like the oral medication Gilenya. Depending on where you are in the US medical health care system (high/middle/low level) - you might or might not have to jump through those hoops.

My impression - after living 68 years in the US - but perhaps taking 20 trips to Canada - and seeing many Canadians who come here not only to spend the winter but to get health care too - is that younger'healthier/poorer people in Canada are more likely to get better and more affordable health care there. OTOH - older/sicker/wealthier people do better off here. I doubt my 97 year old father would have gotten the exotic biliary stent procedure he needed in < 48 hours after he first presented to his doctor with a case of jaundice in any country other than the US.

We were last in Canada in 2014. Toronto, And some old local people we encountered at our hotel bar were lamenting how the Canadian health care system no longer paid for the better health care they had gotten accustomed to in Florida during their winter vacations. Robyn
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Old 01-25-2016, 05:53 PM
 
Location: Toronto, Ontario, Canada.
2,540 posts, read 3,267,628 times
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Adamsaj.


You have been listening to the US medical insurance company lobby.......


I deal with the Family Practice Unit at Women's College hospital, here in Toronto, as does my wife. We have been patients there for more than 10 years. It is a complete one stop medical service, with a complete range of specialties, and they are a part of the University health Network, that is comprised of 14 hospitals in Toronto.


I can call today, and see my MD tomorrow. If I need to have a lab sample done, its on the 4th floor of the same building. Medical imaging is on the 6th floor. My Cardiologist in on the third floor, and on and on. Women's Colleges slogan is "We are the Hospital designed to keep people OUT of the hospital". They mean it, too.


Now, obviously, if you live in a isolated town of 4,000 people 400 miles away from the nearest bigger city, your situation will be somewhat different.....But because we don't have to depend on private, for profit air ambulance services, we can fly people to the required treatment centre, in our Government operated paramedic helicopters. We also make great use of the system of "doctors on the internet " to do consults and long distance patient reviews " using high definition cameras and screens.


You asked about a CAT scan....... I had one a few months ago, at 2am on a Saturday night, at Mt Sinai, on University Avenue in Toronto. They are used around the clock, 24/7. My results were electronically sent to my MD a hour later. All of my medical records are in the electronic record system, available to any authorised Doctor in Canada, if I am unconscious and can't talk.


Americans have been fed a lot of hooey about health care in Canada, mainly by those who don't want to loose their handle on the golden goose. In Canada, a MD doesn't need to have a collection agency, they know that they are going to be paid, by the Provincial Government. That allows them to BE a Doctor, not a bill collector.


Jim B.
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Old 01-25-2016, 07:18 PM
 
Location: Asheville NC
1,601 posts, read 1,311,930 times
Reputation: 4155
Default Estradiol

Quote:
Originally Posted by Robyn55 View Post
I did run across one plan that covered Premarin (with high co-pays) when I was comparing Part D plans in my area during the open enrollment period but it was like $90/month (I'm paying about $25/month now). Bottom line was the plan didn't make "dollars and cents/sense".

What are you taking now?

I am not sure that those of us who have had hysterectomies/BSOs - no plumbing left - are at high risk with something like Premarin. Unless we have (significant) family histories of breast cancer. I've been on Premarin for 30+ years now - since a hysterectomy/BSO. Can't say it helps with anything in particular. But it doesn't seem to hurt either. Any "reviews" would be appreciated,

My GYN recently prescribed a topical vaginal Rx for me - to deal with "thin skin". The yucky gooey cream (Premarin) is covered by my Medicare Part D plan (class 3 drug) - but the tidier pill - called Vagifem - isn't covered at all (and it costs like $300/month for 8 pills). I am not sure what I'll wind up doing. But if I wind up with any of these more expensive drugs not covered under my Medicare Part D plan - I'll be buying them through a Canadian pharmacy (not totally cheap - but cheaper). Robyn
1 mg. Is what I'm taking. I tried cream years ago and it was a no go for me. We bought the higher price cvs Silverscript part D. It will cover most of the donut hole and had the meds my husband takes. I dont have any meds I take besides the Hrt, so I chose the same plan. I agree with you about the risk factor. Having no cervix and no history breast cancer, along with never smoking--the risks with hurt is very low. In fact it helps your skin, bones and heart.
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Old 01-25-2016, 08:33 PM
 
2,633 posts, read 3,371,380 times
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Quote:
Originally Posted by Robyn55 View Post
You're not the freak of nature. My father - who - at age 97 - doesn't take any prescription drugs - is the freak of nature . Robyn

What's his secret?

Good genes?
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Old 01-25-2016, 10:00 PM
 
10,812 posts, read 8,054,817 times
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Quote:
Originally Posted by Robyn55 View Post
Female HRT has been under attack from the medical establishment for a long time. And it is taking its toll on the availability of these drugs on Medicare Part D formularies. This year - AARP UHC dropped Premarin tablets from its formulary. The remaining tablet on the formulary - Estradiol - is only available with prior authorization - comes with a high risk warning - and is a "class 3" drug (monthly co-pays of $23).
I use a very low dose of the cream, have never taken the tablets.
At times the co-pay has been so high that I've been surprised that the tube didn't contain liquid gold. My pharmacist is good about telling me when to stock up and when to wait awhile before refilling.
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Old 01-26-2016, 05:23 AM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,917,951 times
Reputation: 6716
Quote:
Originally Posted by sfcambridge View Post
What's his secret?

Good genes?
Yup. His father lived to 96 - his mother to 103. He has 4 siblings. The youngest died in her late 80's (she was obese and had a lot of related health issues). His oldest sister died suddenly of a stoke in her mid-90's. A younger brother and sister are alive and doing well in their mid-90's. There is no history of heart disease or dementia in the family. My father was also the first person in his family to be diagnosed with any cancer (other than sun-related skin cancer). Pancreatic cancer - about 6 months ago. He was given 6-12 months to live - but seems to be doing fine so far - status quo.

Some members of the family - including my father - have age-related orthopedic problems. Like my brother the doctor says - at their ages - the engine is still running fine - but the chassis is falling apart .

My father isn't in any hurry to die. Especially before the Super Bowl . Which is why I am always somewhat amused by younger people here saying they have no desire to live long lives unless they're in perfect condition. Robyn
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Old 01-26-2016, 06:04 AM
 
Location: The Carolinas
2,003 posts, read 2,016,393 times
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@Canadian Citizen.


Thanks for your reply. I had no ulterior motives in asking my question. Was simply trying to get your perspective. Would you say that your experience is universal?
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Old 01-26-2016, 06:23 AM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,917,951 times
Reputation: 6716
Quote:
Originally Posted by canadian citizen View Post
...Americans have been fed a lot of hooey about health care in Canada, mainly by those who don't want to loose their handle on the golden goose. In Canada, a MD doesn't need to have a collection agency, they know that they are going to be paid, by the Provincial Government. That allows them to BE a Doctor, not a bill collector...
I suspect some doctors are happy with the system in Canada. But others aren't. In the last year - I and members of my family have seen 2 new doctors here at Mayo JAX. Both surgeons. Both born in Canada and educated in Canada up to a point. They went to medical school here in the US and now practice here. I suspect their decisions to stay here - and the decisions of other doctors - have a lot to do with pay (especially in higher paid surgical specialties).

FWIW - my general impression of the Canadian health system is it seems to be ok most of the time in terms of dealing with patients who are in life-threatening/emergency situations in a timely fashion. Not so OK when it comes to situations that are less urgent - or not urgent at all. Say something like a knee replacement. My general impression was confirmed during our last trip to Toronto. We drove from Toronto back into the US (to Michigan). And - along the way - in Canada - we saw billboards advertising physician services in the US. Things like MRIs and orthopedic services. I can't see any reason why US doctors would advertise in Canada unless there are Canadians who are unhappy with some aspects of the medical care they're receiving there.

Note that the Canadian government sometimes pays for services that Canadian citizens get in the US:

Canadians visit U.S. to get health care | Detroit Free Press | freep.com

Still - it strikes me as odd that a large prosperous province/city like Ontario/Toronto has to ship some patients to a (bankrupt) city like Detroit to get medical care.

Finally - I think your impressions may be colored by what you're paying for your health care as a lower income person. Which seems to be less than what a higher income person might pay. For many middle or higher income people in Canada - health care is far from cheap:

'Free' Health Care in Canada Costs More Than It's Worth*|*Nadeem Esmail

Robyn
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Old 01-26-2016, 06:36 AM
 
Location: Toronto, Ontario, Canada.
2,540 posts, read 3,267,628 times
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Adams aj.


Obviously, individuals will have their own perspective on their health care experience..........


I will suggest that those who are what I call "self educated " about their health, will be more likely to be proactive about it. By that I mean that they will read up on new developments, and be more aware of their own body.


Of course, with the availability of good care here, Canadians don't have to "wait until they are really sick " before seeing a Doctor, as many Americans seem to do. In fact here in Toronto there is a "visiting Doctor service " that is covered by OHIP. They are available 16 hours of each day, and the service is free. Home visits by a MD, ever hear of that in your US locality ?


here is a link to that service. Welcome to Medvisit


I can't speak for the other 35 million people who live in Canada... But in many online discussion forums, the vast majority of us are satisfied with our medical care, when asked about it by American questioners.


Jim b.
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