More adventures in ODB-land

Macro of background made from pills and capsules


Last week I called in my regular prescriptions for the first time since I became eligible for the Ontario Drug Plan in June. I have been taking all four drugs for years and the combination of my retiree plan from Towers Watson and my husband’s plan at BlackBerry meant that before my husband retired there was never a charge to us when we cashed out at the drugstore.

One of these drugs is 200 mg capsules of Celebrex which I take once a day for osteoarthritis. The ODB refused to pay for this medication unless the doctor provided a code that confirms I had stomach bleeds on other NSAID drugs like Advil or Ibuprofen,

Since this was not the case, in order for my retiree medical plan to pay for the drug, the pharmacist had to verify that the ODB (the first payor) refused coverage. The prescription cost was $47.17 for 90 days. Ultimately the Towers Watson plan with Green Shield paid all but $9.43 (the 20% co-pay).

Now a copay of $9.443 is not a significant amount in the grand scheme of things, but it does raise several issues. If a doctor prescribes Celebrex because she believes it is a better fit for her patient’s condition, an individual covered only by the ODB may have to pay the whole shot. And if the patient  takes Ibuprofen or Advil instead she will also be out-of-pocket (albeit by a smaller amount) because these medications are classified as over-the-counter drugs and not covered by the ODB.

So when you are planning for retirement, commit to saving a little bit more for unexpected medical costs that you may have after age 65 for drugs and paramedical services. After all, better to be safe than sorry!




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