Is a doctor's prescription needed for an APAP machine in Ontario?

[antinatalism]

I ask about APAP (https://www.tuck.com/do-cpap-bipap-and- ... scription/) as it looks more discriminating and so more helpful than CPAP.

I'm trying to help my mom whom Dr. David Kanawaty in Toronto diagnosed with sleep apnoea, after her GP referred her to him. She needs a machine that befits her frequent traveling. I'm leery of him, as he simply told her to buy a machine and that no further appointments were necessary. Her GP also didn't prescribe, or say anything else.

1. Ought Kanawaty have written a prescription?

2. Even if a prescription isn't required, oughtn't Kanawaty help her choose APAP supplies, and follow up? Why didn't he prescribe another sleep test for her after she acquires the APAP supplies?

[Dog Slobber]

Yes, a prescription for a CPAP device is required in Ontario.

It's also a requirement to be eligible for OHIP's 75% assisted devices coverage.

I think it's very strange that her Dr. didn't give her a prescription and cut her loose so abruptly. The process for me (also in Ontario) was:

• Family Dr referral to Sleep Clinic
• Sleep Study
• Consult with Sleep Study Dr - given prescription
• Referral to DME for equipment testing and purchase
• Ongoing support with both Sleep Study Dr and DME

Regarding APAP vs CPAP

I insisted on an APAP device, I wanted the benefits of APAP but knew I could use it as a CPAP device, if it turned out I had to use CPAP.

Here is a link to the specific devices covered under OHIP's assisted devices coverage program:
http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

I would suggest a new referral to a different sleep clinic.

[ChicagoGranny]

Something's rotten in Denmark.

[antinatalism]

Thank you both! I'll ask my GP to refer her to another Sleep Doctor. Something's rotten in Canada, verily.

[ChicagoGranny]

Thank you both! I'll ask my GP to refer her to another Sleep Doctor. Something's rotten in Canada, verily.

Don't forget to come back here for advice on anything from understanding sleep study results to picking out a machine and mask to solving common problems. It's good to have a support team - viewtopic/t48844/Why-is-it-necessary-to ... -team.html

[Hose_Head]

Yes, a prescription for a CPAP device is required in Ontario.

It's also a requirement to be eligible for OHIP's 75% assisted devices coverage.

I think it's very strange that her Dr. didn't give her a prescription and cut her loose so abruptly. The process for me (also in Ontario) was:

• Family Dr referral to Sleep Clinic
• Sleep Study
• Consult with Sleep Study Dr - given prescription
• Referral to DME for equipment testing and purchase
• Ongoing support with both Sleep Study Dr and DME

Regarding APAP vs CPAP

I insisted on an APAP device, I wanted the benefits of APAP but knew I could use it as a CPAP device, if it turned out I had to use CPAP.

Here is a link to the specific devices covered under OHIP's assisted devices coverage program:
http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

I would suggest a new referral to a different sleep clinic.

Good advice.

A few added points.

For some unexplained reason, the Resmed S10 Autoset for Her is classified as an approved CPAP by Ontario ADP. In other words, Ontario Assistive Devices Program (ADP) will pay 75% of the cost of this machine as a CPAP, even though it is an APAP.

Also, you don't have to buy an APAP through ADP. If you can convince your doctor to prescribe an APAP regardless of eligibility for one under the strict rules of Ontario ADP, then you can get an APAP if you agree to pay for it yourself. Any DME will accept such a prescription and there also are Canadian online sources to buy for a good price.

The doctor may have given the Rx and sent it direct to the DME. Normally doctors send the prescription directly to the DME and you never see it. This is easiest for you but it limits your ability to chose your DME or to buy online (they are not all equal). It's highly recommended that you get a copy of the prescription from the doctor.

[DavidY]

Ontario is one province that regulates the pricing of CPAP/APAP thru their ADP program....this is very good for those in Ontario, not so much for those outside Ontario.

Cpapmachines.ca doesn't require a prescription (see their FAQ). They are in Ontario. Their pricing isn't ADP approved however....this is good if you are paying for the unit yourself (i.e. not through ADP). I have been told that you would have to pay 25% of the CAD$10xx of an APAP from an ADP-approved dealer (just over $1000).

Any family doctor can prescribe an APAP/CPAP device. I had to tell my family doctor the prescription requirements...as my sleep clinic/DME (based on his referral) wouldn't give me a copy of the prescription. Sleep clinic/DME charged my insurer CAD$2500 ($2175 for the Resmed Airsense 10 Autoset and $325 for a nasal mask). A few months later, I bought the same unit, but as the For Her model (has an extra mode) online from another CPAP online dealer, CPAPoutlet.ca for CAD$805 without a mask. CPAPoutlet.ca requires a prescription.

Dave

[GHM]

My experience has been very positive and I’m sorry to hear your Mom has been struggling with the process.

I was referred by my GP to the Paris ON sleep clinic, about 1.5 hrs from Toronto. I went for a sleep study, went back for a discussion with the Dr. They gave me the choice of what DME to use. They sent my script to the DME, I never saw it.

I got a loaner machine and a couple different masks to try. The machine sent the results via cell to my DME who monitored the results. They called a couple days in to make sure it was working, any questions etc.

I went back to Paris for a follow up study on CPAP to set pressures and that recommendation from the Dr was sent to the DME who set the pressure. After a month (you need to show compliance to get OHIP) I received my machine. I’m still looking to find the perfect mask but they have given me multiple styles to try and I’m probably as good as I will get as a stomach sleeper with a beard.

I would see if your GP will give you a referral to an different DR but for me a lot of my info has been from the DME. The Dr was professional but really didn’t say too much beyond going through my results. I didn’t have a follow up after the 2nd test, the Dr sent the pressure confirmation to the DME directly (it was the same as what was set by the DME based on the data coming in from the loaner).

It was a pretty easy process for me. It sounds like you got a Dr that either doesn’t take the time to explain things or expects the DME to do the explanation.

[D.H.]

I did some googling and found that the situation in Ontario is similar to the situation in the U.S.

That is, you can get a CPAP anyhow (perhaps surreptitiously), but insurance will not pay for any part of it. There is public insurance in Canada, which in this case operates similarly to the mixed system in the U.S.

The bigger problem is that if you don't have a prescription, you probably don't have a sleep study and likely don't even have medical consultation.

[Julie]

The health and insce. system(s) in Canada are very different from those in the US.

[Cpapian]

Greetings! I ask about [APAP](https://www.tuck.com/do-cpap-bipap-and- ... scription/) as it looks finer, more discriminating and thus more helpful than CPAP.

I'm trying to help my mom whom Dr. David Kanawaty in Toronto has diagnosed with sleep apnoea, after her GP referred her to him. She needs a machine that befits her frequent traveling. I'm leery of him, as he simply told her to buy a machine and that no further appointments were necessary. Her GP also didn't prescribe, or say anything else.

1. Ought Kanawaty have written a prescription?

2. Even if a prescription isn't required, ought not Kanawaty help the patient choose APAP supplies, and follow up with the patient? Why didn't he prescribe another sleep test for her after she acquires the APAP supplies?

Travel xpaps are usually a disappointment (waste of money) and are not covered under Ontario's ADP program.

Dr. Kanawaty is a pulmologist with fairly decent reviews on rate my md.

If your mom doesn't have a Rx for a XPAP, a phone call should resolve that. In Ontario doctors are not allowed to recommend a DME so he shouldn't have sent the Rx directly to the DME.

you didn't say specifically if your mother had an overnight sleep study in a lab. If she did, you are entitled to a copy of the results. Drop into their office to pick up a copy. This will give you a better understanding of her condition.

In Ontario, a GP cannot write a Rx for xPAP that is to be paid for by the ADP program. The Rx has to be written in accordance to the sleep study, which, obviously the GP didn't conduct.

Also, in Ontario, under the ADP program, the machine prescribed has to be in line with the results of the sleep test and other sleep criteria. Doctors are audited for compliance. The patient doesn't get to choose whether it should be CPAP, APAP or BIPAP. They do get to choose what brand of machine they want.

How it went for me, I had an overnight sleep study at a lab and was diagnosed with severe sleep apnea. I was given a Rx for a rental xPAP. Then after a couple of months was sent for an overnight titration sleep study (that is with a machine) where they played with pressures to identify my ideal pressure(s). With the results from my overnight titration and couple of months of at home use, I was given an APAP Rx. There were meetings before and after each overnight study.

I was prescribed an APAP but asked the doctor to write the manufacturer and model on the Rx because I knew the DME was going to be difficult on that point because of the anomoly in the ADP pricing schedule. They get less for the her model.

You didn't say how old your mom is or if anyone has accompanied her to her medical visits.

[antinatalism]

you didn't say specifically if your mother had an overnight sleep study in a lab. If she did, you are entitled to a copy of the results. Drop into their office to pick up a copy. This will give you a better understanding of her condition.

In Ontario, a GP cannot write a Rx for xPAP that is to be paid for by the ADP program. The Rx has to be written in accordance to the sleep study, which, obviously the GP didn't conduct.

Also, in Ontario, under the ADP program, the machine prescribed has to be in line with the results of the sleep test and other sleep criteria. Doctors are audited for compliance. The patient doesn't get to choose whether it should be CPAP, APAP or BIPAP. They do get to choose what brand of machine they want.

Thanks. Yes, she had an overnight PSG at a sleep clinic. She's 65. She was alone for these visits and saw Dr Kanawaty alone.

Yes, a prescription for a CPAP device is required in Ontario.

It's also a requirement to be eligible for OHIP's 75% assisted devices coverage.

I think it's very strange that her Dr. didn't give her a prescription and cut her loose so abruptly. The process for me (also in Ontario) was:

1. Family Dr referral to Sleep Clinic
2. Sleep Study
3. Consult with Sleep Study Dr - given prescription
4. Referral to DME for equipment testing and purchase
5. Ongoing support with both Sleep Study Dr and DME

3. I'm bewildered. My 65 y.o. mom completed Step 2. But why's the next step a consultation with Sleep Study Dr?

4. Shouldn't she see a DME first? if she doesn't, how can the Sleep Study Dr know which machine to prescribe in the Rx?

[ChicagoGranny]

She's 65. She was alone for these visits and saw Dr Kanawaty alone.

Uh-huh. If she's single, let her have fun.

[prodigyplace]

The health and insce. system(s) in Canada are very different from those in the US.

Ontario has had government run health insurance for many years. I remember dealing with OHIP (Ontario Health Insurance Plan) in the 1970s. No for profit health insurance companies.

[Ograx]

I'm in Canada and I didn't want to wait to get approved for any government program and jump through their hoops so I just bought my APAP on amazon.

I'm in Saskatchewan and the only one not covered 100% minus a one time 250$ fee for the government program is the APAP. All the other fancy machines are covered just not the APAP.

Another thing I found out is even though my insurance company will pay for masks,wipes,hoses,etc. They will not pay a dime for a machine because there is a government program in my province that does.

My Autosense 10 Autoset cost me around 650$ on Amazon.