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Each of the provincial governments in Atlantic Canada has drawn a clear line on funding of approved cancer treatments:
- If it is an IV drug that needs to be administered in a hospital outpatient setting it will be funded by provincial goverment 100%.
- However, if it is something taken outside of hospital (oral or injectable), it is the patient's responsibility to pay for it.
This is unlike the western provinces where approved cancer drugs are funded 100% regardless of how one takes the drug
As pointed out by the CanCertaintyCoalition of patient groups, the future will see oral cancer treatments dominating the market. Since 2012, approximately 60% of the cancer treatments that have been reviewed for potential coverage by the pan-Canadian Oncology Drug Review have been oral drugs. The average price tag for these drugs is $7,500 per month.
Issue Number 1: Patients in Atlantic Have Less Private Insurance Coverage
Atlantic Canada has a lower rate of those with private drug insurance than the rest of Canada (29.8% according to Canadian Life and Health Insurance Association, Facts and Figures 2012) Many of these plans are small, leaving significant leftovers in co-payments and/or covering a limited amount of prescription drugs per year. Some patients have a cap of $2,000 for the entire year. This is related to the nature of many of the industries in Atlantic Canada that are seasonal and small. Many in Atlantic Canada are self-employed with little to no coverage at all
Atlantic Canadians with significant insurance cost leftovers and those without coverage rely on provincial prescription drug programs to fund their oral cancer treatments (in NS, this is called "Pharmacare"). Every Atlantic province has a seniors drug program that typically covers these drugs with some but reasonable leftovers.
Issue Number 2: Patients Face Significant Deductibles that Many Simply Cannot Afford
Only Nova Scotia and Newfoundland/Labrador have a "universal" public drug coverage program that covers those under age 65, but each program leaves significant leftovers and requires information on the household’s gross taxable family income to determine how much help they can receive (Note that patients are never asked about their income when they need an IV drug because the hospital simply provides it with the provincial funding.)
How Much Do Individuals Pay?
Nova Scotia typically requires patients on their univeral public program ("Family Pharmacare") to pay for their prescription drugs up front until a certain amount is reached (called a "deductible"). Once that amount is reached then they will receive 80% coverage. That amount varies greatly by income and has been criticized publicly for unrealistic expectations of affodability since its inception in 2008.
- For example, a person with a gross annual family income of $35,000 would have to pay $1400 + a 20% copayment before receiving any help from Family pharmacare. This means if that person required a drug that cost $6,000 per month, that person would have to come up with $2600 to be able to start the drug.
- A person with a gross annual family income of $70,000 would have to pay $7,700 + a 20% copayment, so that person would have to pay $9,700 for that drug before any help would be received. Comparatively, a person over 65 on NS Seniors Pharmacare would only pay $382 in a copayment for the year.
What about NL, NB, PEI?
In Newfoundland and Labrador, the program is similar, but puts a cap on deductibles that range from 5-10% of gross income.
New Brunswick currently requires those under 65 to apply for prescription drug benefits through the welfare system (Note: that will change May 1 and access will be reasonable, with coverage kicking in right away.) However, NB typically lists fewer oral oncology drugs than either Nova Scotia or Newfoundland and Labrador. If the drug a patient needs is not on the provincial formulary, the new program of coverage will not apply.
PEI's catastrophic drug plan is similar to Nova Scotia and New Brunswick, but puts a cap on deductibles that range from 0-12% of gross income.
Issue Number 3: Mountains of Paperwork and Tax Forms Required!
With patients under 65 facing signficant leftover costs on their oral cancer treatments, each Atlantic province relies heavily on the financial assistance provided through pharmaceutical-sponsored "patient assistance programs" or "PAP's" (i.e. the makers of the drug set up a program help to the patient with the cost, often requiring another financial assessment - including a copy of their tax assessment).
All of this paperwork and bureaucracy takes TIME. There is a significant time delay to treatment for those without adequate private health insurance. It can take anywhere from 1-6 weeks to arrange funding, while those needing an IV drug simply get booked in to the chemo unit the following week...
The Bottom Line:
It's time for the provincial governments in ON, and each of the Atlantic Provinces to come to the assistance of cancer patients. Fund the oral cancer treatments using the same system as used for intravenous. Cancer is Cancer. Treatment is Treatment. Fund them equally.
Support this campaign. Share with your friends and colleagues. Make a Donation if you can. It's time Canadians spoke up and we addressed this issue for cancer patients today and in the future.
Earlier this week I sat down with an oncologist from Brampton, Ontario to ask about this oral versus intravenous issue and how it affects the patients he sees. He said quite plainly that ONE in every THREE patients he sees has trouble accessing cancer medications due to the cumbersome process for approvals.
It goes like this:
Oncologist makes the diagnoses and chooses the right drug, which just happens to be an oral drug.
Does patient have insurance? No. Then they have to fill out the forms for Trillium...sometimes there is a Medicines Reimbursement Specialist to help because this is an extensive process requiring income tax information from everyone in the household. Sometimes the patient has to do the paperwork themselves because one third of cancer centres don't have someone to help. Sometimes the patient is just overwhelmed and doesn't understand why they have to do this. Or has language issues. Or hasn't filed their taxes because they have been ill.
And then they wait... could be 4 weeks, could be 6 weeks for Trillium to get back to them.
The oncologist must also do the paperwork for the EAP program in Ontario (Exceptional Access Program). That application, along with the patient's medical information, will be reviewed by the EAP office (actually by an oncologist under contract with EAP) to determine eligibility. Sometimes the application is denied. And then the initial oncologist fills out more paperwork to appeal. (Of note: this is not the case for intravenous drugs from CCO. The oncologist makes the order online according to eligibility criteria.)
Six to eight weeks later, the patient has a second appointment. Their condition appears to have deteriorated. They still have no drug.
In Ontario, if this was an intravenous drug, Cancer Care Ontario has a mandate that all patients should wait no longer than 2 weeks from consult to first treatment. For oral cancer therapy, there is no mandated timeframe.
Patients wait for private insurance. They wait for Trillium. They wait for EAP. and they find out how much they will have to pay themselves. And how they will afford it.
Unfortunately cancer cells don't wait until the funding gets sorted out.
Tumours grow. Patients get sicker. And then they (we) lose our best chance to keep this disease in check.
Is that fair? We have a cancer system in Ontario. Let's make it a cancer system for all Ontarians for all cancers and all drugs that are provincially approved.