Treatment Matters: Assisting a Veteran With Medication Coverage

Various medications on a table
January 21, 2020

Those who rely on medication to keep health issues in check understand how vital daily treatment is. Treatment can also be costly if an individual does not have the appropriate coverage.

For one Veteran who contacted our office, medication and coverage were at the center of their worries.

The Veteran suffered from an uncomfortable condition that causes areas of the body to go numb and feel cold in response to cold temperatures or emotional stress. Over time, the condition can cause small arteries to thicken slightly, further limiting blood flow.

For many years, the Veteran managed the pensioned condition with medication covered by Veterans Affairs Canada (VAC.) However, when their physician changed the prescription from a pill form to a liquid form, VAC stated that they could not link it to the Veteran’s pensioned condition and would not pay.

When the Veteran reached out to the OVO for help, they had been trying, unsuccessfully, to get the drug reapproved by VAC for many months.

Upon assessing the situation, the OVO noted that the Veteran’s medication had been covered for decades prior to the switch from pill to liquid. Veterans are entitled to treatment for their pensioned conditions.

An OVO Intervention Officer sent the file to VAC and requested they coordinate with the Veteran’s physician to get the necessary medical information for an approval.

VAC contacted the pharmacy unit within Medavie Blue Cross (MBC,) who informed them that no one from VAC had actually reached out on the Veteran’s behalf to discuss the coverage issue.

A medical consultant at MBC approved the medication with a retroactive reimbursement for 18 months.

After a year and a half trying to get the medication paid for, the Veteran could finally receive the medication they were entitled to.

Sometimes, our job is to create action where there has been inaction. This story illustrates the impact that action can have.