Schedule F: The Chain Link Fence to Keep Sick People Out of Canada


Permanent Resident CardI recently was discussing the issue of the cost of drugs inside versus outside Canada. One of the side-effects of the strong controls present in the Canadian system is that it forms a fence around Canada further making immigration for someone with a medical condition challenging.  This is because of the way the existing law is written.

The cost of certain drugs is much lower outside Canada.  While we can discuss the relative merits of this, such as this recent Forbes article or this recent book on the topic, the bottom line is that the cost of drugs in Canada is high – in some cases as much as 10x higher than the same drugs are from a reputable manufacturer (Cipla, Teva, etc.) in a different country, such as India, where patent rights differ.  One thing that makes this even more difficult in Canada is the blanket prohibition of the importation of certain drugs, currently on a list known as Schedule F, though this is in the process of being replaced by a similar scheme that makes it easier for Health Canada to manage the list.

The purpose of the list, however, is to prohibit the importation of certain drugs into Canada unless one is a doctor, a pharmacist or a hospital.  A patient may bring in a 90 day supply for personal use – but that doesn’t allow the drugs to be shipped.

So, how does one get around this?  Well there are a few options:

  • You can find a sympathetic doctor willing to receive the medications – essentially to serve as the “importer”.  This can be tricky, as some doctors are not willing to accept the potential liability of these non-Canadian approved drugs.  Still, some doctors are a bit more sympathetic.  It can be difficult to find such a doctor. One good thing about the new regulations is that they would extend the importation ability to anyone with the legal right to prescribe in the province.  Here in BC, for example, naturopathic doctors have prescription rights for many things and thus would be allowed to import drugs in some of these cases.  That increases the potential pool of doctors willing to assist.
  • You can arrange for delivery to the US border and then pick up a 90 day supply every three months.  Services like Kinek charge a modest fee for receiving a package for you in the US.  The US has an exception to the importation ban when the drugs are for personal use, which makes it easier to import them into the US.  Then you can bring them into Canada under the 90 day personal use exception.
  • You can try to find a Canadian pharmacy willing to sell the drugs to you.  For example, here in BC there’s a pharmacy in Surrey (Blue Sky Drugs) that indicates they will ship to Canadian addresses; whether this constitutes importation by a Canadian pharmacy or not is something that I will admit is definitely not clear.
  • You can “take your chances”.  This is what people who don’t have to worry about immigration do.  In my experience these services will reship anything that doesn’t arrive.  This is definitely a grey area, as they are exploiting the fact that CBSA cannot police every package and thus only a small fraction are actually seized.

For someone trying to convince CIC that they have a credible plan this situation can be problematic: some officers at CIC know about Schedule F and can use it as a means to refuse someone from being granted permission to immigrate.  In that case the best thing is to find a sympathetic doctor willing to allow shipments of the meds to them.  The doctor might be more willing if they know the drugs are coming from a foreign charity (NGO) rather than an internet pharmacy;  the patient may need to sign a written release indemnifying the doctor in case the drugs provided are ineffective or contaminated – after all, the doctor has no way of being able to verify the veracity of the drugs any more than the patient.  Were I trying to come to Canada and had a foreign NGO willing to provide me with expensive (or overpriced – depends upon your perspective) drugs, I’d be happy to indemnify a doctor willing to help me get into Canada in the first place!

Of course some types of drugs are worse than others.  In January 2013, Gilead reported they had a 76% profit margin.  AIDS Healthcare Foundation has been calling for moderation of their prices, but at the present time that’s the way the system works – the laws protect the companies’ profits not the health and well being of the actual patients.  For those wishing to immigrate to Canada this creates a real barrier to entry.

Canada in turn only looks at a few diseases very closely.  I personally know of people with heart conditions (requiring multiple surgeries and hospital stays after coming to Canada) who disclosed their conditions but were not subjected to the “excessive demand” fire drill.  But this is what the Canadian public has decided to do.  Immigration is always fraught with this sort of problem – a deep-seated xenophobia.  That’s hardly unique to Canada, sadly.

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BC Health Care revisited


 

BC Care CardBack in April I mentioned a Huffington Post article about a woman here in BC who had to give birth in a hotel here rather than in hospital because she was not yet eligible for provincial health services.

Since that time I have learned that in fact this really wasn’t the case and that in fact BC really is quite generous when it comes to granting medical care to those with PR applications in process.  Since I found this to be useful information, I’m going to capture it here as well in hopes that it will be useful to others in the future.

Bottom line: the spouse of a BC resident living with that resident in BC is normally eligible for coverage as well according to documents on the BC MSP website:

Most immigration documents, when submitted with the required MSP form, provide sufficient information for MSP to determine whether a person qualifies for benefits. There are circumstances, however,  where additional documentation is required. If, for example, a spouse/child has visitor status in Canada and his/her papers do not state “Case Type 17” or provide any other indication that permanent resident status has been applied for, the MSP form should be submitted with copies of as many of the following as possible:

  • a photocopy of any immigration document he/she may hold
  • any relevant letters issued by Citizenship and Immigration Canada (CIC)
  • proof that the application fee for permanent resident status has been paid to CIC online or through a financial institution
  • the identity page of the spouse/child’s passport and any other pages stamped by CIC or the Canada Border Services Agency
  • a copy of the spouse/child’s birth certificate if he/she is a United States citizen.
  • pages one and two from the CIC e-Client Applications Status website (www.cic.gc.ca) showingthe receipt date of the application. (On that website, click on Check Application Status.)

The above helps confirm that CIC considers the person to be an applicant for permanent resident status, and helps MSP determine when, if appropriate, coverage should begin.

Thus, it would seem that had that woman submitted evidence they had submitted the application (payment receipt, evidence that it was received in Vegreville, AB) she likely would have been eligible.  Instead, the original point of the article was that she wouldn’t qualify until such time as she was granted AIP (initial approval).

I’d been looking at this recently in any case, because of the opt-out provision of the BC provincial plan (as far as I can tell, only BC and Alberta have such a provision, although hopefully if there are other options for other provinces someone will tell me and I can update this information).  For me that was important because it demonstrated one possible way out of the excessive demand argument and indeed, had there been [b]any hint[/b] from the visa officer that no amount of insurance would overcome the BC policy, I would have offered to opt-out.  All I received was a generic form letter – and the only text in the medical officer’s opinion that deviated from the standard language that provides no insight into the rationale of the officer was “This applicant’s medical condition is likely to require treatment that is expensive and publicly funded in B.C.  Although he has private insurance, antiretroviral medications are covered 100% by the provincial drug plan in the province of British Columbia with no payment from private insurance.”

Previously, this same medical officer (in a different case, with the same medical condition): “Admissibility is dependent on the visa officer determining if the clients will have access to private or employer based insurance”.

Thus my point – I’ve investigated insurance alternatives.  It’s not easy to [b]get[/b] insurance with a pre-existing condition but it isn’t impossible – there are actually brokers who deal with that sort of thing (albeit with restrictions).

Of course, now that’s a moot point – CIC didn’t communicate clearly, so there was no effective way for me to respond back to them.