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Bev Thompson was diagnosed with kidney cancer in February 2009.
“We were told there was a new drug called Sutent on the market with a 90 per cent success rate,” says Thompson’s daughter, Krista.
Sutent was approved by Health Canada in 2006 to treat digestive and kidney cancer. All provincial drug plans cover the costs in some way.
But just because a drug is available, approved for use and proven effective does not mean it will be covered by Canadian health plans. Nexavar is another drug that treats liver cancer, but some provinces, such as P.E.I., will not reimburse patients who use it.
So, not all brand names are approved by provinces — if A does the job and is cheaper than B, provinces are unlikely to pay extra to cover prescriptions for B.
Bottom of the barrel
The Rx&D International Report on Access to Medicines 2008/2009, released in early November, compares public drug plans in 25 of the world’s most developed countries. Canada ranked 20th.
Rx&D is a national umbrella group representing more than 50 research-based pharmaceutical companies in Canada.
“Our system has a flaw and it needs to be fixed,” says George Wyatt, president of Wyatt Health Management, the organization that conducted the study. The company provides expertise to pharmaceutical companies on how to make a product more marketable.
Once a drug is manufactured, Health Canada must deem it safe. Then the Canadian Agency for Drugs and Technologies in Health steps in. This is an independent, not-for-profit agency funded by the government to provide advice to Canadian health care decision makers. Under CADTH, the Common Drug Review exists to assess the clinical and cost effectiveness of drugs. It is the Canadian Expert Drug Advisory Committee of this body that makes formulary recommendations to the provinces.
Each province has a formulary, a list of drugs supplied under various plans. A national formulary also exists to list the medicines that are approved for prescription throughout the country.
CEDAC may recommend a drug be "listed," be "listed with criteria," "not listed," or a recommendation may be deferred pending clarification of information.
"When CDR says do not list, the provinces take it as do not reimburse."— George Wyatt
“There’s a problem here. When CDR says 'do not list,' the provinces take it as 'do not reimburse,'” says Wyatt.
The report looked at 82 drugs that have received market authorization in at least 15 countries. CDR recommended only 56 per cent of drugs submitted for review. In other words, 56 per cent of the drugs reviewed were covered by a health plan. The reimbursement average was 73 per cent.
Wyatt says CDR should never make a "do not list" recommendation. He says provinces routinely shy away from reimbursing new drugs based on CDR’s recommendation. According to him, the recommendation should always be "list with criteria."
“People are being denied appropriate therapy,” Wyatt says. “If a patient doesn’t get a drug covered, they might go to a hospital or seek more medical tests. What’s the sense in that?”
Finland, Portugal and Denmark had the highest public reimbursement percentages — above 95 per cent — for the 82 drugs studied. Poland and New Zealand ranked lowest with percentages below 50.
The report found that patients living with rheumatoid arthritis or HIV/AIDS in Canada have a good chance of getting access to the drugs studied in the report.
The same cannot be said for a patient with osteoporosis or an overactive bladder. Canadian public drug plans have a five per cent reimbursement rate for overactive bladder drugs while the rest of the countries in the study average 81 per cent.
Apples and oranges?
Some argue Wyatt’s study is generalizing and doesn't look at the issue on a micro-level.
"Just because the drug is new, doesn't mean it's better."— John Yan
“The report fails to see the fact that countries have different needs. It compares apples with oranges,” says John Yan, director of communications and government relations for CADTH.
“Just because the drug is new, doesn’t mean it’s better,” says Yan.
According to the CADTH website, three things are considered when making a recommendation: How does it compare with alternatives? Which patients will benefit? Will it deliver value for money?
“If we don’t recommend a particular drug, it’s because it didn’t meet our study for cost effectiveness,” Yan says. “It’s like a student buying a new computer. You have to weigh your options against what your needs are and what kind of budget you have.”
Roger MacPhee, a health policy expert with Wyatt Health Management, says it’s important to draw comparisons.
“If you don’t know what’s happening elsewhere, you’re less able to evaluate what’s going on in your own country.”
Rarely covered drugs
Several medications were listed in the Rx&D International Report on Access to Medicines 2008/2009 that most provinces do not cover.
Memantine: Memantine, often sold under the brand names Ebixa and Akatinol, is a drug used to treat Alzheimer’s disease first authorized in 2002.
Eletriptan: Eletriptan, an oral medication used to treat migraine headaches, is usually sold as Relpax.
Teriparatide: Teriparatide, often marketed as Forteo, was the first osteoporosis drug to actually create a new bone.
Rasagiline: Usually known as Azilect, rasagiline is used to treat Parkinson’s Disease. Reimbursement for the drug is currently under review in Prince Edward Island, while the majority of other provinces do not reimburse for it at all.
Drug plans in Canada
Public Service Health Care Plan: This plan is meant for employees of the federal government, including the RCMP, federal judges and members of Parliament, among others.
Canadian Forces Health Services: Canadians who serve in the Canadian military, including reserve forces, may be eligible for certain benefits from the federal government. This includes prescription medications and injectable drugs, among other benefits.
Interim Federal Health Program: This plan was introduced for refugees and asylum seekers who come to Canada to receive essential health care.
Veterans Affairs Canada: VAC provides various benefits to recognized veterans of the Canadian military. It has its own drug formulary, meaning some presctiptions covered by VAC may not be covered by the provinces.