Canada’s not-so-universal health care

After 16 years of medical marijuana programs, still no pharmacare for cannabis-based medicine

In July of 2001, Health Canada established the country’s first regulatory system for legal medical cannabis, formally acknowledging the plant’s efficacy as a medicine. More than a decade and a half later, Canada’s national health care infrastructure has yet to list cannabis and its derivative medicines for the same insurance coverage granted to other medicines and treatments. While insurance administrators drag their heels, Canadian families are struggling to pay medical bills out of pocket.

This lack of coverage is causing one family in North York, ON, to rely on a crowdfunding campaign to pay for their 2-year-old daughter’s anti-seizure CBD treatments. Delilah Krupka was born with cerebral palsy (CP), caused by a single vein having developed too small in her brain before birth, leading to a stroke in utero. For the first year of her life she suffered from repeated seizures and spasms—as often as 50 spasms per hour, every day.

Delilah’s parents and doctors attempted traditionally prescribed treatments, but all of the anti-seizure medications they tried that were covered by Ontario’s pharmacare came with side effects including loss of appetite, which is crucial to any infant, and especially so for an infant in recovery from a prenatal stroke and developmental disorder. As a result of one of her previous prescriptions (a bitter medicine administered by sprinkling on food) she also developed an aversion to food itself, and now has to be fed by feeding tube to ensure she receives enough energy and fibre to survive.

After celebrating Delilah’s first birthday during a month-long stay at the SickKids Hospital in Toronto, her mother Bella met the parent of another child who suffered from CP, and who had found success in treating the condition with CBD oil. Bella consulted with Delilah’s physician, and reached out to Dr. Michael Verbora, medical director at the Cannabinoid Medical Clinic.

A short time after beginning CBD treatments the frequency of Delilah’s seizures and spasms both saw significant reductions, from 50 spasms per hour to just 20 spasms per day on average, as well as secondary benefits as a result of the reduction in seizures.

“Delilah has developed better in the 7 months since starting CBD treatments,” said Mrs. Krupka, “than she had in the rest of her two years.”

The universe is waiting

CBD coverage is just one aspect of a larger universal pharmacare discussion that has long been called for by provincial and federal constituents. Canada is often lauded by US lawmakers for its comprehensive health care system, highlighting its contrast from the American status quo of families going bankrupt when loved ones injure themselves or are diagnosed with medical conditions. But there’s one area of health care coverage in which Canada remains as stagnant as its southern neighbour.

Among the 62 countries worldwide that have instituted universal health care, Canada stands out as the only developed nation that has not yet instituted universal pharmacare as part of its health care umbrella. So when the Krupkas saw the results the new CBD treatments had for their daughter, they were dismayed to find the medicine was not covered by either their provincial health care or Delilah’s father’s employee benefits.

Faced with the choice of returning to the previous treatments that are covered by pharmacare, knowing it would likely mean a return to nearly one spasm per minute for Delilah, or somehow finding an extra $700 per month to cover her medicine, the Krupkas decided to follow the lead of countless Americans similarly neglected by their country’s lack of coverage: they started a GoFundMe campaign.

So far the campaign has raised enough money to cover a little over a year’s worth of CBD treatments, but Delilah will require more frequent, higher dosage treatments as she grows in size and as she transitions off other medications.

Currently Delilah requires five anti-seizure medications and one hormone treatment for a separate thyroid condition. All but the CBD treatment are covered by Ontario’s pharmacare and Irek’s—Delilah’s father’s—employee benefits. After seeing the improvements in Delilah’s condition as a result of replacing previous treatments with CBD oil, the Krupkas are eager to further reduce the remaining prescriptions (and their respective side effects). But that may require increasing the dosage of CBD, which is thus far financially out of reach for the family.

Precedents

One recent case that came before a human rights board in Nova Scotia may have made a significant leap forward for cannabis coverage in Canada. An inquiry in February of 2017 resulted in the ruling that the Canadian Elevator Industry Welfare Trust Plan, which provided insurance to Nova Scotia resident Gordon Skinner, violated the province’s Human Rights Act when it denied Skinner’s claim for coverage of his legally issued medical cannabis.

"Denial of his request for coverage of medical marijuana,” declared the ruling, “amounts to a prima facie case of discrimination."

The insurer was ordered to cover Skinner’s cannabis expenses in full.

While most Canadian underwriters are leaving their customers out in the cold for cannabis coverage, two insurers are leading the charge on progressive coverage policy. In 2016, Sun Life and BMO Insurance became the first insurance companies in Canada to grant coverage for medical cannabis expenses, and have already started paying out claims.

University of Waterloo student Jonathan Zaid was one of the first to receive cannabis coverage through his student union health plan, with Sun Life having reimbursed roughly $2,000 for cannabis and a vaporizer he had purchased the previous year.

Although some Canadians are starting to be covered, that’s a far cry from the average Canadian having the comfort and security of knowing their health care will be assured should they fall ill, be injured, or otherwise find themselves in need of costly medical treatments.

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3 comments

  1. jim gunn Reply

    The State liquor monopoly in Ontario (LCBO) makes the taxpayers pay for their employees marijuana.

    1. Stacy Reply

      You mean their medicine? Their legally prescribed medicine, without the horrible side effects of so many other chemically-based pharmaceuticals? Did you know we are all, including you, born with cannabinoid receptors in our brain, just waiting to be used to treat (and cure) various diseases?

      I understand you aren't in favour of monopolies in our, um, province. We are not the United States. This issue, however, isn't about socialism (not a bad word, as I am sure if you live in Canada you are very grateful for your socialist taxpayer paid universal health care). It's about health insurance companies (whose premiums are, in essence, paid for BY THEIR EMPLOYEES, indirectly through their labour (only paid by the employees' company, as part of an employee's benefits package) avoiding coverage for a legally prescribed medication, from qualified doctors, for serious issues. You have to be referred to one of these doctors, for the most part. It's not just someone's marijuana. That's simplifying the issue to the extreme.

      If you are going to make a comment about something, either positive or negative, you have to educate yourself about the issue. If this was a negative comment written by someone with the full picture, I would love to debate it. Since this isn't, why don't you do some research, and then rephrase your comment? If not, you can always move to the US, if our 'monopolies' bother you so much, then move to the US, to pay for your own health care out of pocket at exorbitant prices, along with prescription meds, with costs that are not regulated by our excellent 'socialist' government policies, so that the unfortunate US citizen is gouged by big pharma.
      You can always move to the United States, if our 'monopolies' bother you so much.

  2. Stacy Saman Reply

    So unfair! I have been bothering my insurance company for many months to try to get my legally obtained prescription (and referred by one of the best MS neurologists in Ontario, by the way) covered. It covers Sativex, the FAKE spray. Does this make sense? Well, if you are a pharmaceutical company out to make money, it does. I'm sure the pressure they are giving our insurance companies to refuse coverage for MM is insane. Claiming the bills on our taxes just doesn't cut it. It doesn't have a DIN number, which is the only reason my insurance company states it won't cover it. Health Canada needs to give it one. There are published studies now, so no excuse!