Pushing the Trillium program

An HIV-positive Toronto man who says he was at risk of having to go without his medications has reached an agreement with Trillium, the provincial drug assistance program — without missing a pill.

Brian (a pseudonym; he fears being publicly identified as HIV-positive may impact future employment) was downsized out of a job last year. Without private insurance coverage and no source of income except for RRSPs and rent he collects from a basement apartment, Brian went to the province’s Trillium Drug Program for help.

A 48-year-old former account manager for a telecommunications company, Brian’s original deductible was calculated at nearly $5,000 to reflect his 2008 income. Knowing his supply of meds — which cost approximately $3,000 per month — would be up by early August, Brian says he pleaded with Trillium reps to conduct a reevaluation before the usual August start date but says they refused.

“I’ve lost my job and I have no EI [Employment Insurance],” he says. “I don’t want to rip off the government at all. I’ve paid huge amounts of income tax for decades. All I’m saying is be fair with me today in my current financial situation.”

Ministry of Health and Long-term Care spokesperson Andrew Morrison declined to discuss the case, citing client confidentiality. But he did confirm that ministry staff are currently working on reassessments. “The Trillium Drug Program calendar has just rolled over as of Jul 31,” he says, “so they’re in the process of making the assessments and I understand that they have 105,000 files to go through.”

Created in 1995, the Trillium Drug Program was designed to assist Ontario residents with high prescription drug expenses. Recipients of the program pay an annual deductible of approximately four percent of their yearly income.

Murray Jose, the executive director for the Toronto People with AIDS Foundation (TPWAF), says the organization has seen a number of cases where individuals have received Trillium assessments based on higher past incomes.

“Certainly this was something that we were seeing with people with HIV/AIDS where people had moved onto disability from a salaried position or a position that had a higher wage, and it became quite a challenge to meet the deductible that was based on that previous position,” he says.

But Jose points out that changes to the program now allow applicants to present documentation of present income that may allow deductible payments to be reduced.

For those in urgent need Jose says TPWAF has a financial assistance program to help cover drug costs as well as a treatment access program to help people receive short-term access to HIV meds.

“We’re often able to in one way or another facilitate getting people short-term access to their medications,” says Jose. “So whether they’re travelling and their baggage got lost and they’re in Toronto for the week and don’t have their meds but have documentation, or whether there’s just a gap in coverage for some reason, we’re usually able to facilitate and work with some of the pharmacies to help them. Not always, but quite often.”

Last week, Brian was granted his reassessment after appealing to the Ministry of Health and various elected officials. While he says he isn’t totally happy with the amount he’s being asked to pay — $1,884 — he says won’t appeal it a second time.

He admits that people may not be as sympathetic to his case when compared to those with HIV/AIDS who are worse off financially. “There might be a lot of people… who might not be that sympathetic and say, ‘This guy used to make $100K. What is he complaining about?’ But that’s not the issue. The issue is that Trillium is there for instances like this.”