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Chemotherapy coverage by OHIP?
Crys
7 Posts
Hello! I’ve been reading some of the forums and discussions and I’m trying to determine if my dads chemotherapy is covered by OHIP.

The oncologist at credit valley did not mention any costs but she did recommend Abraxane and Gemzar for chemo. Is there a list of coverage explained somewhere? It is to treat stage IV a pancreatic cancer that has also metastasized to the liver.

It would also be nice to hear other experiences and know what to expect. My father is 78 and has pre existing conditions such as diabetes, high cholesterol and heart disease which the doctor is of course aware of but I am terrified I won’t know when to take him to the hospital.

any advice is greatly appreciate!
8 Replies
Brighty
6210 Posts
Crys‍ hi. Chemo is covered by OHIP. Before he starts chemo he should be given a binder of all the information. He should also have chemo teaching before he starts. In the binder there will be a list of possible side effects from the chemo... and a number should be in there with a 24 hour nurse hotline to call if you see any unusual symptoms. He should also be given a 'card'that says he has cancer so if he is taken to hospital he will be seen as priority. .....the chemo nurses are usually very kind and will take care of him. He needs to keep hydrated and perhaps bring a snack..as it can be a long day. They used to give snacks but not sure if thry do now due to covid. There are tvs there or he might want to bring a book to read. Thry will take his blood to see if the red blood count is ok then proceed with chemo if all is well. Thry will also give him anti nausea meds . If I recall any other details I will get back to you.
Crys
7 Posts
Thank you Brighty‍ this is really useful!!!
Kims1961
1994 Posts
Crys‍ Great questions!

Brighty‍ did an excellent job responding so i don't have much to offer. She is correct in that chemotherapy is covered by OHIP. I had other medications prescribed to help with nausea - which as your dad is over 65 - should also be covered. Most cancer centres also have a staff person to help with medication costs, applying to other sources to get meds covered if necessary.

In a way, your dad having other conditions will help, as they will be sure to take all of this into account when doing treatment. For me, a fever was a key indicator that i needed to head to ER. As Brighty‍ mentioned they will go over that and please feel free to ask them if you are unclear at all....there is no "dumb" question.

Your dad is very lucky to have you. Take care, Kim
Crys
7 Posts
Kims1961‍ thank you for the additional info!!! I appreciate it so much.
S2020
11 Posts
Crys‍ I am sorry you and your father are going through this.

If your father will be receiving chemo in the hospital, it will be covered by OHIP. If he will be receiving oral chemo that he takes at home, it will not be covered by OHIP. If he requires Lapelga injections after his infusions, that is not covered by OHIP. Also, the anti-nausea medication, Akynzeo, that I had to take at the hospital before every infusion was not covered by OHIP. They may give your father something else for nausea. Your oncologist or hospital pharmacist will let you know.

For any medications not covered by OHIP, your father may be eligible for funding through the Ontario Drug Plan and/or Trillium. It might be worthwhile to apply for that now even if he doesn’t need it in case there is a medication he needs in the future. A hospital social worker will help you complete the forms.

It was surprising for me to learn how much was NOT covered by OHIP. I was relieved to hear there was assistance available to help with costs. Even with my previous full-time income and a frugal lifestyle, I could not pay for all of it. Family and friends who had cancer treatments did not have to pay for anything so I think it must vary, depending on what chemo/meds an oncologist orders, etc.
Marsh
108 Posts
When I had chemo everything was covered except the the Grastofil injections that I was prescribed. I did 8 daily injections starting on day 3 of my chemo round. At the time I was 64 so not covered under the Ontario Drug Benefit and I had no other prescription drug coverage. The cost of those injections was High! Community Care covered the cost for me. I am very grateful for this program. The hospital set it all up for me. Any chemo administered in hospital is covered by OHIP. But oral chemo is unfortunately not. Why? I do not understand!
Crys
7 Posts
Thank you S2020‍ this is useful to know - I hope as my father is 65+ that some will be covered but will definitely speak to the social workers about the forms you mentioned to be proactive about completing anything. I appreciate your honest and openess about the potential costs, always good to have an idea of what to expect!
Crys
7 Posts
Thanks Marsh‍ I'm glad it was able to get covered through the program for you! Not ideal as to why some are covered and others are not but hopefully the flaws in the system will be improved soon - fingers and toes crossed!!!
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