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Hello,

I have decided to move back to Canada after 30 years in the states. I was a teenager when my family left, and I have dual citizenship. I'm considering Winnipeg or Thunder Bay due to proximity to family, cost of living, etc.

I never much accessed healthcare when I was younger. I just remember going to our family GP for a check-up and not thinking much of it. However, things are obviously different in the US. I now have a chronic mental health condition. It's very well controlled via a few different medications. I've gone on to earn a bachelor and master's degree and have had a wonderful career. Overall, as long as I have access to my medication and care, it's a non-issue.

I'm concerned about continuity of care and what I should do. How do I find a GP to take over my medications? Will they continue to prescribe (one is a sedative that I have taken for years-never been abused EVER). Should I get my entire medical record prior to moving? I'd ideally like to have a plan and find myself in a pickle once I've moved. Intended move date is Sept. of 2018.

Thoughts and suggestions?

Thanks,
J.
 

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Ex pharmacy technician here... it's been a while since I last worked in Canada (in Vancouver, BC) but maybe I can help...

Hello,

I have decided to move back to Canada after 30 years in the states. I was a teenager when my family left, and I have dual citizenship. I'm considering Winnipeg or Thunder Bay due to proximity to family, cost of living, etc.

Welcome home!

I never much accessed healthcare when I was younger. I just remember going to our family GP for a check-up and not thinking much of it. However, things are obviously different in the US. I now have a chronic mental health condition. It's very well controlled via a few different medications. I've gone on to earn a bachelor and master's degree and have had a wonderful career. Overall, as long as I have access to my medication and care, it's a non-issue.

You'll need to sign up for provincial medical coverage when you get here... you can find the application forms, premium costs and other pertinent information online at the relevant provincial government website.

There's a mandatory 90 day waiting period before coverage begins and it doesn't matter if you send in your application on the 1st or 90th day of your arrival, so I'd say that if you know your first address in Canada before you arrive (it can be a friend or relative's address, it doesn't matter, as long as it's an address within the province) send your application off as soon as you arrive so that any problems can be sorted out before your cover begins.

With that in mind, you should get some medical insurance to cover yourself for the first 90 days of your arrival back in Canada. Don't know much about how much this will cost nor do I have any suggestions as to whom to go with but you should be able to find something in a Google search.

Also, you should bring enough medication with you to cover your first 90 days... if you can manage a 120 day supply, that's better, but I'd recommend 90-100 days so that you can get through the waiting period and have enough left over until you can get in to see a doc for a further supply.

Health care can be cheaper in Canada than the US but for the uninsured who need immediate assistance, visit fees and prescription charges can add up quickly.

I'm concerned about continuity of care and what I should do.

You should also be able to find, on the ministry of health section of the provincial government website a listing of the docs who are accepting new patients
Pick a few of them and call them directly to see if they're accepting new patients - the listing might not be up to date and/or the GP may have decided to stop taking new patients since the list was last updated. If in doubt, there are walk-in clinics that accept regular patients.

How do I find a GP to take over my medications? Will they continue to prescribe (one is a sedative that I have taken for years-never been abused EVER). Should I get my entire medical record prior to moving? I'd ideally like to have a plan and find myself in a pickle once I've moved. Intended move date is Sept. of 2018.

I'd say bring the last few years of your medical history with you so that your new Canadian GP can have a look at what has been prescribed for you and how you've responded to treatment. Your GP may change your meds slightly to bring your current prescription in line with Canadian prescribing standards and conventions (if any change is necessary the change is usually to a different med within the same drug class and with this substitution sometimes comes a change in dosage so I wouldn't be immediately alarmed by this... your new GP should be able to explain the changes to you) but if all is well with your history and prognosis, I can't see why you're not continued on what you have been taking until now.

Please keep in mind though that there are differences in drug laws between Canada and the US; while most medicines available in the US are also available in Canada (much to the surprise of many Americans I used to serve when they would come to Canada for cheap prescriptions) there are exceptional drugs that aren't available here or, if they are available, they're "special access" (where your GP has to write to Health Canada for permission for you to have the medication before it can be dispensed to you). I don't know what ails you (and I don't need to know) but most (if not all) of the more commonly prescribed meds from the US are available in Canada.

I'd recommend having a look at and enlisting any one of the online Canadian pharmacies to do a quick search to see if each of your meds is available in Canada.. you don't need to buy anything from the online pharmacy rather just use their search engine to see if your US prescription med is available in Canada.

Interestingly, while one can't get Cortisone 10 (1% hydrocortisone ointment for skin itch) without a prescription in Canada, you're more than welcome to rock up to the pharmacy counter and buy yourself a bottle of Tylenol with Codeine; it's only been within the last 15 years or so that one has been able to buy Aleve in Canada without a prescription yet one has always been able to get Zyrtec (the antihistamine cetirizine) over the counter... crazy, I tell you.

Another note, unless you have prescription cover as part of 3rd party insurance (think Blue Cross/Blue Shield and the like) you will have to pay for your prescriptions. The cost of your prescription is comprised of two parts... the drug cost (this cost is static and is the same at any pharmacy... the various drug companies sell to pharmacies through a wholesaler) and the dispensing fee... there is no mark-up on the drug cost but the dispensing fee can and does vary from chain to chain (here's an article about dispensing fees in Canada) and you're well within your rights to shop around... Costco and Walmart tend to be the cheapest while places like Shoppers Drug Mart are the priciest (you'll note that Target was mentioned in the article... they were in Canada but closed up shop because while Canadians love Target USA, they weren't shopping there as voraciously as they do in the US as the prices in Canada were way higher than in US stores... I love Target and shop there when I'm in the US [I love the one on Nicollet Mall in The Cities... it's my favourite]).... if you get your prescriptions initially filled at Safeway and decide that you want to go to Costco for your repeats, you are free to go to Costco and have them transfer your remaining refills over from Safeway ... you'll need to know the location of the Safeway pharmacy where your prescriptions are at and the names of your meds so that the pharmacist at Costco can have them transferred (if you have your Safeway prescription bottles with you, that's even more helpful) but otherwise nobody can stop you from changing pharmacies... heck, if you're away from home (but still within the province) and find that you have inadvertently run out or are about to run out of meds, you can have 1 repeat transferred from your home pharmacy to a pharmacy that is local to where you are so you don't run out.

When you receive your prescriptions, unless your doc prescribes otherwise, meds for chronic conditions are generally dispensed in 3 month quantities with 2 or 3 repeats.


Thoughts and suggestions?

Thanks,
J.
 

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Hi J. I don't mean to hijack this thread at all but I have further questions on what you said, looking for clarification.

I am in the same boat as OP, living in the US looking to get back to Canada. If I hear you correctly what would be a good idea is to see if I could get up to 120 days' worth of meds to have them while the provincial medical coverage kicks in after 90 days. Do you know what is involved with the provincial medical coverage? In other words if I know the address an I apply for it before I even get back to Canada, or are there dates and appts where I have to be there for verification that I'm back?

Second, you spoke about transferring over prescriptions from the US to Canadian pharmacies. I would tend to lean towards what you suggested which is to get a list of medication and the history of why I (medically) went down the path I did from my doctor(s). I take ketamine, prescribed by a psychiatrist, and know that that's a harsh medication and I don't think it's easily come by. I'm sure you know a lot more about it than I do. My question there is (well, a point first, I don't think I'd be able to get 90 days' worth let along 120 for this) what, in your opinion, are the chances that the right doctor will keep the prescription going?

Lastly, I currently have blue cross/blue shield. Would I be able to use that insurance in canada for the first 90 days until things get processed if I can't get 90-120 prescribed ahead of time? I'm guessing the 90 days is in order for medicare to kick back in?

Thank you for all your help so far, even though I had nothing to do with the thread so far. :)

Steven
 

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...

Hi J. I don't mean to hijack this thread at all but I have further questions on what you said, looking for clarification.

I am in the same boat as OP, living in the US looking to get back to Canada. If I hear you correctly what would be a good idea is to see if I could get up to 120 days' worth of meds to have them while the provincial medical coverage kicks in after 90 days. Do you know what is involved with the provincial medical coverage? In other words if I know the address an I apply for it before I even get back to Canada, or are there dates and appts where I have to be there for verification that I'm back?

I think that you just send in your application and once it's processed, they'll contact you again to arrange payment (monthly, quarterly, semi-annually, annually... options vary from province to province, so it's hard to say what you'll be offered)... at least that's what the BC Ministry of Health did when I returned to Vancouver after being away for 2 years - this was back in 2007.

I don't know how it works in other provinces but BC MSP (medical services plan) sent me a card in the mail with my personal health number on it that I could use, once my coverage kicked in and I was offered the choice of making premium payments monthly, quarterly, semi-annually... I think I paid monthly for a few months before I found a job that included medical coverage.

You have to be physically in the province before you apply... they'll ask you for the date that you first entered and while I wasn't asked to prove the date, I wouldn't be surprised if they reserved the right to ask for proof of first entry, if they were suspicious of anything.

You are more than welcome to print and fill out the paperwork before you leave the US and mail it off once you arrive in Canada (which is what I did... I had my application filled in and an envelope addressed and as soon as I reached my parents' home, I mailed it off) but you need to be in the province when you apply.


Second, you spoke about transferring over prescriptions from the US to Canadian pharmacies. I would tend to lean towards what you suggested which is to get a list of medication and the history of why I (medically) went down the path I did from my doctor(s). I take ketamine, prescribed by a psychiatrist, and know that that's a harsh medication and I don't think it's easily come by. I'm sure you know a lot more about it than I do. My question there is (well, a point first, I don't think I'd be able to get 90 days' worth let along 120 for this) what, in your opinion, are the chances that the right doctor will keep the prescription going?

No, you cannot transfer prescriptions between the US and Canada. I said that prescriptions can be transferred between pharmacies within the province, but you cannot normally present an out of country prescription and expect to get it filled in Canada.

You would have to get your prescriptions filled before you entered Canada or go to a walk-in clinic, pay for the visit out of pocket, get a prescription for your medications and then present that to your local pharmacy.

You can take your current US based prescriptions with you to your new doctor in Canada and they can review your history with you and work out a care plan for you.

Ketamine is not currently approved in Canada for use in depression, although there are anecdotal reports of its use off label. There is some research being done in Canada surrounding the use of ketamine in treatment resistant depression but so far, it's not been officially approved for that.

I don't know how you would go about finding someone to prescribe it for you nor do I know how likely they would be to continue your use of it. I would suggest inquiring with the Canadian Mental Health Association and asking them if they have any information or guidance to offer you in regards to finding someone to continue your treatment.

Lastly, I currently have blue cross/blue shield. Would I be able to use that insurance in canada for the first 90 days until things get processed if I can't get 90-120 prescribed ahead of time? I'm guessing the 90 days is in order for medicare to kick back in?

Blue Cross does exist in Canada but I don't think that you can get cross-border cover unless Blue Cross/Blue Shield USA is willing to cover you in Canada... you'd have to contact them directly to see if there's a reciprocal agreement between the US and Canadian branches of the company, but I wouldn't hold my breath.

If Blue Cross/Blue Shield don't cover you, then do a Google search for names of underwriters who offer this type of cover and see what they are asking for as far as premiums go. I can't offer a recommended underwriter as it would depend on what your needs are (also, it's been ~5 years since I last worked in Canada and, even at that, I worked in a hospital sertting, so I'm unfamiliar with specific insurers.


Thank you for all your help so far, even though I had nothing to do with the thread so far. :)

Steven
 
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