Does the policy apply?

Authority Interior Health Authority

Angela had been receiving medication as an outpatient at the hospital for many years. One day the hospital pharmacist gave her a letter stating that the hospital would no longer cover the medication she was taking. Angela later learned that the decision was made for budget reasons. Concerned about the hospitals’ decision to stop funding her medication, Angela went to Interior Health’s Patient Care Quality Office (PCQO). Angela needed the medication regularly to address her chronic health issue, but it was expensive and was not covered by PharmaCare. Angela paid for the medication for a while but she lived on only a disability benefit and could not afford to keep paying for the medication herself. After PCQO conducted a review, the hospital decided to reinstate funding a few months later but denied her request to issue a refund. Not satisfied with the decision, Angela came to our Office. We investigated whether Interior Health adequately responded to Angela’s request to have her costs reimbursed for the period she was paying out of pocket for the medication. Interior Health confirmed that the change in policy did not apply to individuals who previously received the medication in question, and they agreed to compensate Angela for the almost $700 she had spent on the medication while it was not covered. Angela contacted us to confirm that she received the cheque from Interior Health and thanked us for our help. 

Category Health
Type Case Summary
Fiscal Year 2017