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Volunteer Advocate

Access to Trikafta by Location

Trikafta is finally coming to Canada! 

After nearly two years of hard work from the Canadian cystic fibrosis community to fight for access to Trikafta, and decades of hope for a drug like this, there is now nothing standing in the way of the provinces and territories funding Trikafta. As announcements are made by provinces and territories about public access to this miracle drug, Cystic Fibrosis Canada will provide updates via this page.  

For information about your individual circumstance please reach out to your CF clinic with any questions you may have. 

Current access situation by Location

The federal government has several drug programs which should offer some degree of coverage of Trikafta for eligible people.

Non-insured health benefits for First Nations and Inuit (NIHB) Cystic Fibrosis Canada has reached out to the administrators of NIHB who have confirmed they are in the process of completing an agreement with Vertex for the funding of Trikafta.

Other federal drug plans

Other groups covered by federal drug plans include eligible members of the Canadian Armed Forces, qualified veterans by Veterans Affairs Canada, members of the Royal Canadian Mounted Police. Please see the Canadian government website for more information on these programs and who is eligible.

1. Is Trikafta available in Alberta through public drug programs?

Yes, Trikafta was added to the Alberta Drug Benefit List (ADBL) on September 24, 2021. Trikafta is available via Special Authorization.

You must have active Alberta Health Care Insurance Plan coverage to qualify for Alberta’s drug programs. Alberta’s drug programs are separate from the Alberta Health Care Insurance Plan (AHCIP). AHCIP pays doctors and other health care providers to provide certain health services.

2. What are the criteria for accessing Trikafta through public funding?

In order to qualify for public funding of Trikafta in Alberta you must be aged 12+ with at least one F508del mutation. Pre-treatment testing and information is required for initial coverage. Please speak to your clinic team for more information.

3. How can I access Trikafta under Alberta’s public drug programs?

To access Trikafta through Special Authorization you must qualify for one of the following Alberta drug programs:

  • Non-Group Coverage (aka Blue Cross)
  • Coverage for Seniors
  • Palliative Coverage
  • Child and Family Services
  • Alberta Child Health Benefit
  • Children and Youth Services
  • Income Support
  • Learners Program
  • Alberta Human Services (AISH)
  • Alberta Adult Health Benefit (AAHB)

Once you have determined which Alberta drug program you may qualify for you need to work out if you need to apply for the program. More information on these programs and their application processes can be found on the Alberta website.

4. How can I/ my child access Trikafta through Non-Group Coverage (Blue Cross)?

The Non-Group Coverage program, administered by Alberta Blue Cross, may pay for some or all of the cost of Trikafta. To qualify, you must live in Alberta and be under 65 years of age.

There is an application for the Non-Group Coverage program and a monthly premium is charged. Single coverage is available to Alberta residents with no dependants and family coverage is available to Alberta residents with eligible dependants.

5. How do I/ my child get Special Authorization to access Trikafta?

Once you are enrolled in Non-Group Coverage or another Alberta drug program, you/your child may qualify for access to Trikafta through Special Authorization. You will need to speak to your CF clinic about accessing Trikafta through this program, as they will have to complete the application form as well as some additional processes and steps in order for you to be considered for public funding.

6. I/my child have private insurance, how can I access Trikafta?

If you or your child have private insurance, you should contact your benefits provider. Individual policies and group benefit plans govern what is and isn’t covered. Private insurers have internal review processes for drugs and can take a while to add new drugs to their coverage. Alberta Blue Cross Non-Group Coverage will coordinate benefits with your private insurance provider.

7. What if I have private insurance but my insurer won’t cover Trikafta?

See question 4. about applying for Non-Group Coverage to access Trikafta through Special Authorization.

Alternatively, please contact us at advocacy@cysticfibrosis.ca and we can refer you to Vertex’s Village, a program that may be able to assist you. Cystic Fibrosis Canada continues to reach out to private insurers regarding coverage.

8. I have private insurance but my insurance won’t pay for the full costs of the drug. What can I do?

See question 4. about applying for Non-Group Coverage to access to Trikafta through Special Authorization.

Please contact us at advocacy@cysticfibrosis.ca and we can refer you to Vertex’s Village, a program that can potentially assist you. Cystic Fibrosis Canada continues to reach out to private insurers regarding coverage.

9. I qualify for coverage under one of Alberta’s drug programs. What do I need to do to get Trikafta now?

To access Trikafta you must undertake baseline testing before you will be considered for the drug. This may take some time. Please speak to your CF clinician about the required tests and paperwork.

There are clinical criteria that must be provided for you to be considered for coverage through Special Authorization. Please speak to your CF clinician about these criteria as they relate to your personal health status. This will help determine what your next steps should be.

British Columbia is providing access to Trikafta through its Expensive Drugs for Rare Diseases program, which offers access on a case-by-case basis. We are awaiting confirmation of the criteria that will be used to determine access.  

On October 22, 2021, Manitoba announced that Trikafta will be publicly funded in the province. Trikafta will be be available for Manitoba residents who meet the provincial eligibility criteria and who qualify for Manitoba Pharmacare or receive health coverage from Employment and Income Assistance. Manitoba’s government has not yet confirmed the start date for funding, or the access criteria. We have reached out to learn more. 

In a letter to Cystic Fibrosis Canada on October 19th 2021, the Newfoundland and Labrador government announced that it is expediting the listing process for Trikafta so that patients with cystic fibrosis can have access to this drug under the Newfoundland and Labrador Prescription Drug Program in November 2021. They have not yet confirmed the start date in November or details on access criteria. We have requested this information and will provide more information as soon as possible. 

On October 13, 2021, in a statement released to media, the government of New Brunswick confirmed their intention to list Trikafta before the end of the month.  

Alberta administers the Northwest Territories drug program on behalf of the Territories. We have reached out for more information on reimbursement status in the NWT and will share news as soon as we hear. 

On October 14, 2021 Michelle Thompson, the Nova Scotia Minister of Health, confirmed Nova Scotia’s intention to fund Trikafta. In response to a question from Zach Churchill, Yarmouth MLA and former Minister of Health, Minister Thompson stated: “The Trikafta drug will be added to the Nova Scotia formulary.” We have reached out to confirm start date and criteria for funding. 

Eligible residents of Nunavut may be covered under NIHB. See the section above regarding federal coverage for more information on drug access for Inuit people.

For those who are not covered by the NIHB, cystic fibrosis is listed as a condition covered by the Extended Health Benefit. Please see the Nunavut government website for more information on this program and eligibility.

1. Is Trikafta available in Ontario through public drug programs?

Yes, Trikafta was added to the Ontario Drug Benefit program on September 30, 2021.

The Ontario Drug Benefit (ODB) programs may pay for some or all of the cost of Trikafta. To qualify, you must live in Ontario and have a valid Ontario Health Card. There are several different ODB programs and each program may have additional rules about who can join to access Trikafta.

These drug programs are separate from the Ontario Health Insurance Plan (OHIP). OHIP pays doctors and other health care providers to provide certain health services.

2. Is there criteria for accessing Trikafta through public funding?

In order to qualify for public funding of Trikafta in Ontario you must be aged 12+ with at least one F508del mutation and have a predicted FEV1 of 90% or lower. There may be opportunities to access Trikafta through the Exceptional Access Program if you have an FEV1 of 91% or above. You will need to speak to your clinic about accessing Trikafta through this path, as they will have to complete additional processes and steps in order to be considered for public funding.

3. How can I access Trikafta under Ontario’s public drug programs?

In order to access Trikafta through public funding you must qualify for one of the ODB programs. Which OBD program you can use to access Trikafta depends on your circumstances:If you are over 65 you automatically qualify for the ODB seniors plan

  • If you are 24 years of age or younger and are not covered by a private insurance plan you will be able to access drug coverage through OHIP+
  • If you are receiving professional home and community care services you may be eligible for the ODB
  • If you are receiving benefits from Ontario Works or Ontario Disability Support Program you may be eligible for the ODB
  • If you are between 25 and 64 and have a high cost of drugs relative to your income you can enrol in the Trillium Drug Program

Once you have determined which ODB program you may qualify for you need to work out if you need to apply for the program. Here are a few of the more common access routes to Trikafta, you can find more information on other programs on the ODB website.

4. I/ my child is under 25 and we do not have private insurance, how can I access Trikafta through OHIP+?

If you are or your child is 24 years of age or younger and don’t have private insurance, you may qualify for OHIP+. There is no application process for OHIP+. There is no deductible or co-pay, and people under 25 years of age are automatically enrolled if they do not have private insurance.

5. I/my child is under 25 and we do have private insurance, how can I access Trikafta?

If you are or your child is 24 years of age or younger and you have private insurance, you should contact your benefits provider. Individual policies and group benefit plans govern what is and isn’t covered. Some private insurers wait until our public health plans have done their cost-effectiveness studies before they decide if they will cover the drug, but these cost-effectiveness studies are now complete. Private insurers also have internal review processes for drugs and can take a while to add new drugs to their coverage.

6. Why can’t my child or I qualify for OHIP+ if we have private insurance?

OHIP+ excludes anyone with private insurance. This is a major barrier to access for those under 25 years of age who have private insurance, especially for those whose private insurance does not cover Trikafta.

Cystic Fibrosis Canada is working to change this program, so that no one is left behind. It is not fair nor right to exclude children and youth from accessing medicines. Write to the Premier, Minister of Health and your Member of Provincial Parliament to tell them how not having access to this program is impacting you and your family. Meet with your elected official. Contact local media to share your story. Watch our website and social media channels for news about our advocacy efforts, and please be sure to amplify our collective voices. If you’d like to join our advocacy efforts, please drop us a line at advocacy@cysticfibrosis.ca .

7. I am between 25-64 and do not qualify for any of the other programs. I will need to access Trikafta through the Trillium Drug Benefit. What do I need to do to get Trikafta now?

The Trillium Drug Program may be of assistance if you are between 25-64 years of age and have high drug costs relative your household income. You must apply for Trillium and must meet the eligibility criteria. Among other things, to qualify, you must have valid Ontario Health Insurance (OHIP) not already qualify for the Ontario Drug Benefit program nor have a private insurance plan that pays for 100% of your drugs. You must also spend 4% or more of your after-tax household income on prescriptions drugs. Trillium coverage comes with a deductible and a co-pay.

8. What if I have private insurance but my insurer won’t cover Trikafta?

Please contact us at advocacy@cysticfibrosis.ca and we can refer you to Vertex’s Village, a program that may be able to assist you. Cystic Fibrosis Canada continues to reach out to private insurers regarding coverage.

9. I have private insurance but my insurance won’t pay for the full costs of the drug. What can I do?

Please contact us at advocacy@cysticfibrosis.ca and we can refer you to Vertex’s Village, a program that can potentially assist you. Cystic Fibrosis Canada continues to reach out to private insurers regarding coverage.

The Trillium Drug Program may be of assistance if you are between 25-64 years of age and have high drug costs relative your household income. Trillium will coordinate benefits with your provider. More information on Trillium is provided in Question 7 above.

10. I qualify for coverage under one of the Ontario Drug Benefit programs. What do I need to do to get Trikafta now?

To access Trikafta you must undertake baseline testing before you will be considered for the drug. This may take some time. Please speak to your clinician about the required tests and paperwork.

There are clinical criteria that you must meet to be considered for public coverage. If you don’t meet the criteria, you may be considered for coverage under Ontario’s Exceptional Access Program (EAP). Please speak to your clinician about these criteria as they relate to your personal health status. This will help determine what your next steps should be.

On October 15, PEI became the 6th province to list Trikafta for eligible people, starting November 1, 2021.  It is the first Atlantic province to list the drug.  Access criteria have yet to be announced.

On Wednesday 29th September, 2021 Trikafta was added to Quebec’s public drug program, RAMQ. Due to the drug system in Quebec, this means that, Trikafta will now be covered by both public and private insurers in Quebec.  

It appears that Quebec has kept the same access criteria as what was released in the INESSS recommendation shared on September 2nd. However, patients with a lung function over 90% may have the opportunity to access Trikafta through the “patient d’exception” program, on a case-by-case basis. Please see the RAMQ website for more details.    

We will continue to review the criteria released by the Government of Quebec and will update our website with more information as soon as possible. 

1. Is Trikafta available in Saskatchewan through public drug programs?

Yes, Trikafta was added to the Exception Drug Status (EDS) program on September 24, 2021.

2. Are there criteria for accessing Trikafta through public funding?

In order to qualify for public funding of Trikafta in Saskatchewan you must be aged 12+ with at least one F508del mutation, be receiving optimized treatment for CF at the time of initiation and demonstrate adherence to your prescribed CF therapeutic regimen.

3. How can I access Trikafta under Saskatchewan’s public drug programs?

Access to Trikafta is available through Exception Drug Status (EDS) in Saskatchewan.

The EDS program may pay for some or all of the cost of Trikafta. To qualify, you must live in Saskatchewan and have a valid Saskatchewan Health Card. Once you have a Saskatchewan Health Card you may be eligible for drug plan benefits, including Prescription Coverage and Extended Benefits. You may then qualify for access to Trikafta through EDS, which is part of the Extended Benefits plan.

You can apply for, replace or update your Health Card as a resident of Saskatchewan. Learn more here.

The Extended Benefits and Drug Plan provides additional coverage for eligible individuals on top of the universal benefits.

There is an application process for EDS to be completed by your clinician. Pre-treatment assessments are required for initial coverage. You will need to speak to your CF clinic about accessing Trikafta through this program, as they will have to complete additional processes and steps in order to be considered for public funding.

You can find more information on other programs on the Saskatchewan website.

4. I/my child have private insurance, how can I access Trikafta?

If you or your child have private insurance, you should contact your benefits provider. Individual policies and group benefit plans govern what is and isn’t covered. Private insurers have internal review processes for drugs and can take a while to add new drugs to their coverage.

5. What if I have private insurance but my insurer won’t cover Trikafta?

Speak to your CF clinic about applying for access through EDS.

Alternatively, please contact us at advocacy@cysticfibrosis.ca and we can refer you to Vertex’s Village, a program that may be able to assist you. Cystic Fibrosis Canada continues to reach out to private insurers regarding coverage.

6. I have private insurance but my insurance won’t pay for the full costs of the drug. What can I do?

Speak to your CF clinic about applying for EDS to cover the remaining amount.

Please contact us at advocacy@cysticfibrosis.ca and we can refer you to Vertex’s Village, a program that can potentially assist you. Cystic Fibrosis Canada continues to reach out to private insurers regarding coverage.

The government of Yukon announced on October 15, 2021, that it is in the process of adding life changing drug Trikafta, to its drug formulary. This process is expected to be completed within the next two months.