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Shad Zekry Shad Zekry received a kidney from his wife and had been reimbursed for his brand name anti-rejection medication for years until April. (Katie Griffin\/CTV News). <\/p>\nAn Ottawa man is speaking out after his insurance company denied coverage of a brand name drug he\u2019s been taking for years. CTV\u2019s Katie Griffin reports. <\/p>\n
An Ottawa kidney transplant patient says he\u2019s speaking out because his insurance company is refusing to pay for a brand-name drug he\u2019s been on for years in favour of a generic version, despite a doctor\u2019s note saying it could lead to organ rejection. <\/p>\n
\u201cI don\u2019t feel that it is warranted or fair of an insurance company to ask me to go against my doctor\u2019s wishes and to also say if you insist on (following) your doctor\u2019s wishes, we won\u2019t cover it,\u201d said Shad Zekry, who received a kidney from his wife in 2023. <\/p>\n
Zekry takes Advagraf, the brand name of the drug tacrolimus, every day. It\u2019s used to help prevent organ rejection. <\/p>\n
Shad Zekry Shad Zekry received a kidney from his wife and had been reimbursed for his brand name anti-rejection medication for years until April. (Katie Griffin\/CTV News). <\/p>\n
His insurance plan with the federal government had reimbursed the cost for the last three years until April. <\/p>\n
\u201cThey said, \u2018No, there is a generic medicine,\u2019 and there really isn\u2019t for this formulation,\u201d said Zekry. \u201cWhen I told my physicians, they said, \u2018Do not switch.\u2019\u201d<\/p>\n
Zekry\u2019s doctor says there\u2019s no benefit to switching and that it can put patients at risk. <\/p>\n
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Advagraf Doctors say switching anti-rejection medication Advagraf to a generic is too risky and should be avoided. (Katie Griffin\/CTV News) <\/p>\n
\u201cThere are very few medications that fall into that narrow therapeutic index, but anti-rejection medications are one of them,\u201d said Dr. David Massicotte-Azarniouch, a nephrologist at the Ottawa Hospital and Zekry\u2019s doctor. <\/p>\n
It means even small changes can cause the appropriate dose to be ineffective or toxic. <\/p>\n
\u201cIt\u2019s not that generics are bad, it\u2019s just that in this case, for this medication, you want to keep as much as possible patients on the same brand of medication to avoid that variability,\u201d said Massicotte-Azarniouch, adding his advice would be the same if there was a request to switch between two generic medications. <\/p>\n
In a letter to Zekry, Canada Life wrote: \u201creimbursement at the brand-name cost can only be approved if an adverse reaction to the lowest-cost alternative drug has occurred or is expected to occur.\u201d <\/p>\n
Zekry\u2019s doctor filled out a \u201crequest for brand-name prescription drug coverage\u201d form required by Canada Life that states Zekry needs to continue on the brand name because there\u2019s a risk of organ rejection with a generic. Despite that, the request was denied by Canada Life.<\/p>\n
\u201cAs plan sponsor, the Government of Canada\u2019s Public Service Health Care Plan Authority determines what is covered under their benefits plan. Canada Life administers all claims in compliance with the Government of Canada\u2019s Public Service Health Care Plan Directive,\u201d a Canada Life spokesperson wrote in a statement. <\/p>\n
The Treasury Board of Canada Secretariat said its plan \u201climits the reimbursement of a brand-name drug to the lowest-cost alternative drug available,\u201d adding a doctor can submit the brand name coverage request form to Canada Life \u201cfor review by their medical experts to determine eligibility for reimbursement of the brand-name drug,\u201d which Zekry had done and was rejected. <\/p>\n
Zekry said he plans to appeal the decision. <\/p>\n","protected":false},"excerpt":{"rendered":"An Ottawa man is speaking out after his insurance company denied coverage of a brand name drug he\u2019s…\n","protected":false},"author":2,"featured_media":663253,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[194295],"tags":[712,49,48,20739],"class_list":["post-663252","post","type-post","status-publish","format-standard","has-post-thumbnail","category-ottawa","tag-apple-news","tag-ca","tag-canada","tag-ottawa"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/663252","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=663252"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/663252\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/663253"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=663252"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=663252"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=663252"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}