Medications coverage update

CAPA’s commitment to raising awareness of the benefits of timely access to medications particularly biologic medications for the treatment of inflammatory arthritis is well documented and on-going. Members are involved in government committees and symposiums such as the Expert Advisory Committee on the Vigilance of Health Products and the symposium on optimal prescribing, to name a few. Together with partners such as the Alliance for Canadian Arthritis Program, Arthritis Consumer Experts and the Best Medicines Coalition we stage national and provincial press conferences and workshops. At the grassroots level we advocate independently and collectively to improve the quality of life for all people living with arthritis. The following is a brief overview of some of our successes during the first half of this year.

In January a CAPA News Update advised members of an Alberta government decision to not offer Blue Cross coverage of two new biologic medications, Enbrel and Humira, for the treatment of Ankylosing Spondylitis (AS). We described the behind the scenes initiatives of Dr. Walter Maksymowych, his rheumatology colleagues in Alberta, and seven different arthritis advocacy groups to raise awareness of the government decision, its negative impact on people living with AS who do not have a drug benefit plan, and our joint efforts to influence a re-examination of the decision. The campaign was successful. In June the government announced that Enbrel and Humira will be added to the provincial medication reimbursement formulary for the treatment of AS.

At the end of May ACE and CAPA held a press conference in Toronto to raise awareness of issues related to delays in approving drugs for coverage on Ontario’s formulary. Several MPPs attended and media attention was high. The Ontario government’s record for expediting Common Drug Review (CDR) “recommendations to list” for new arthritis medications is poor. We are continuing our grassroots work to keep this issue front and centre in Ontario.

Since 2006 ACE and CAPA have been diligent in writing to provincial and territorial health ministers advising them of CDR listing recommendations and pressing them to add new arthritis medications to their formulary coverage. Results can be relatively fast or terribly slow. For example, two biologic medications, Rituxan and Orencia received a recommendation to list from the Common Drug Review in February and June 2007 respectively for the treatment of moderate to severe rheumatoid arthritis. They were made available rather quickly. Rituxan is included for coverage in most provinces, the Yukon, and Northwest Territories but under review in Alberta, Manitoba, and Prince Edward Island. Orencia, like Rituxan is widely covered but still under review in the above mentioned provinces plus the Yukon. Enbrel and Humira coverage for the treatment of AS has taken much longer. These drugs are listed in six provinces. Remicade for AS treatment is only covered in BC and Saskatchewan. The first week of July another round of letters will be sent to Canada’s health ministers. All these biologic drugs require Special Authorization. More on this issue in upcoming issues.

Of all the provinces and territories, Quebec is quick to add new drugs to its formulary. The province spends far more money on pharmaceuticals and less on health care than all other provinces and gets better heath outcomes. The Quebec results are not surprising to arthritis advocacy groups. What is surprising is that the other provincial and territorial governments appear indifferent to the Quebec model.

But progress in listing medications is being made in BC. In November 2007 the Minister of Health George Abbott appointed a Pharmaceutical Task Force to investigate PharmaCare’s policy, programs, services and drug approval process. On May 21 Minister Abbott released the Task Force report and announced that the government was accepting all 12 recommendations. This is good news for all people in BC but particularly for those with low incomes and/or without a drug benefit plan because now they will have timely access to medications. The Health Minister’s announcement, Pharmaceutical Task Force Report plus a summary of the recommendations is available on the government website. http://www2.news.gov.bc.ca/news_releases_2005-2009/2008HEALTH0047-000615.htm

CAPA wants to know your concerns and hear your feedback on issues of importance to you that may not have been covered in this update. Please contact us at capaeditor@arthritis.ca.