So basically I wrote a 10 page response letter (yes 10 pages!!) including many points to attack the decision...while every case is different as I said above, I will tell you my main points just as an example...
1-Remicade is not Humira...basically I'm on remicade but the letter used Humira to calculate my costs...the officer did that because he mistakenly though it is a generic compound for Remicade as I will explain in the next point...
2-Remicade is a biologic drug, so it has biosimilars not generic versions....
Regular chemical drugs have generic compounds...means the exact same active ingredient produced in a different brand name by a different company, so those products are basically completely interchangeable. The problem in my case is that the officer (who is most like a general practitioner physician, not a specialist) used Humira to calculate rough costs of Remicade assuming it is a generic compound of remicade (both Remicade and Humira have the same active compound infliximab)...
But that's wrong! remicade is a biologic drug, which means it is produced in live cells...its exact structure and the mechanism by which it works is not fully characterized, thus you can never make a generic compound for a biologic drug...but you can make a biosimilar, and humira is one of remicade's biosimilars. As the name states, biosimilars are expected to work similarly, but not guaranteed to have exact same effect in every patient, in fact the FDA and Health Canada announced that they don't encourage interchangeability of biosimilars. So, there is no logical grounds to use the cost of Humira in stead of Remicade.
But I was still wondering, why did the officer do that? Actually Remicade is much more expensive, so why did he not use remicade in cost calculation and used Humira? the answer is because Humira is supported by canadian public health insurance, while remicade is not supported for new applicants, only for current benefit holders!
So to sum up, my main defence was that I'm on Remicade not Humira, and you can not assume that I can automatically shift to Humira since it is a biosimilar not generic, so not guaranteed to work. Since I never took remicade on governmental support, I will never be eligible for that support and so I can never cost the health system.
Just to highlight why it is so important to do the job on your own, when I told that lawyer the different drug issue his reply was (well you are lucky they used Humira, cause Remicade is even more expensive, so better not remind them!)...luckily I ignored his advice and was able to do my research and know these details...
That was my main defense point, I also added a couple of points asking for a compassionate consideration of my application (again the lawyer mentioned above advised me not to do so unless I can show documents, but I still did) stating I am a researcher in Canada who authored many research papers during my study in Canada so I added and still add to the society. Also because I'm from a less advanced country where health system is not well established, so my disease may progress if I leave Canada, and luckily I found some news reports about a case where the federal court of Canada granted a stateless person from Kuwait asylum and PR in Canada a few years ago because he had Crohn's disease and made the claim that he can't get enough health care support in Kuwait. So I said, while I'm from a different country, my case is quite similar in terms of drug and financial support availability.
I also filled a declaration form that I will pay for my treatment if required, but I'm pretty sure they didn't consider it cause I didn't provide any real plan or document saying I can afford the costs.
That's it, then I sent it to a friend who is an IPR lawyer to read it over and make sure of the formality and so on since he can't judge the content because he is not an immigration lawyer and doesn't know much about it.
Of course I added a governmental website as a reference to support each claim I made, 90% of my references where from healthcanada or FDA websites.
I honestly expected it will take at least 3 months till they reply, and believed my chances are not more than 10%...cause I didn't really provide that letter the lawyer told me about, and didn't add any new documents. Surprisingly, in 2 weeks they changed my status to "Passed the medical exam" and now they require me to send them my passport to be granted the PR confirmation.
I think this is the fastest case of this kind I hear about, never expected it will settle before at least a few more months. Again, my advice is to do the job on your own, do a lot of research and plan your response. Search for points that make the calculation mentioned your fairness letter wrong ot even uncertain.
Finally I would like to thank Mr Computergeek on this forum, he helped put my feet on the beginning of the route and his advises were very precious.