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Private clinics reflect need for drug policy, experts say

From Saturday's Globe and Mail

TORONTO — The spread of private cancer clinics across the country shows how badly Canada needs to develop a national drug formulary, one where patients -- not just the moneyed -- have equal access.

"We have a gun to our heads on this issue right now," said Pat Kelly, national program director of the Campaign to Control Cancer, a coalition of 55 of Canada's leading cancer organizations. "Every single provincial government is going to be faced with this and every cancer agency is struggling."

Provincial governments have been struggling with the high cost of cancer drugs. Not all provinces pay for these medications. This unequal funding of drugs means cancer patients, who need medicine to prolong a remission or add months to their lives, are victims of geography.

Spotty provincial coverage has also unwittingly spelled a business opportunity. Seven private cancer clinics have already sprouted and 11 more are set to open across Canada next month. They offer, for a price, what the public health-care system has been unable to deliver: intravenous drugs not covered by medicare.

Three key players are providing the service: Roche Canada, a drug company that holds the licence for five cancer products; McKesson Canada, which is administering the program; and Bayshore Infusion Clinics Inc., which provides clinical staff and medical equipment.

Cancer patients can buy medicines not paid for by their provincial governments and in some cases, receive financial assistance. Drugs are administered by a nurse, under a doctor's supervision.

What is really needed, though, is a plan that ensures "timely and equitable access no matter where you live," said Ms. Kelly, adding that it is particularly crucial in the case of cancer.

Sharon Sholzberg-Gray, president and chief executive officer of the Canadian Healthcare Association, a federation of provincial and territorial health-care associations, said a common formulary in which drugs are funded uniformly based on the best medical evidence would help address the disparity.

Today, each province has an expert panel that reviews the scientific evidence for a drug, but the panels don't always reach the same conclusions. Consequently, British Columbia may deem one cancer drug cost-effective, while Ontario does not. With one national body, that problem would be erased.

"One of the things that underlies medicare is equivalent access wherever you live in that country," Ms. Sholzberg-Gray said in a telephone interview from Ottawa. ". . . I'm sympathetic to those people caught right now."

Michael Kirby, who wrote a Senate committee report on health care in 2002, said a national drug formulary would mean bulk purchasing of medicines at a much lower cost.

"The big advantage of a national formulary is that it will decrease the cost, coast to coast," Mr. Kirby, a former senator, said yesterday. "The second thing it will do is ensure equity of treatment. That kind of inequity bothers people a lot."

Unequal access to cancer drugs disturbs Toronto resident Hever Arevalo, who has non-Hodgkins lymphoma. He requires Rituxan as maintenance therapy for two years as it has been shown to prolong a remission.

Although the drug is funded for that purpose in British Columbia and Prince Edward Island and on a case-by-case basis in Newfoundland and Labrador, New Brunswick and Quebec, it is not covered as maintenance therapy in Ontario, where Mr. Arevalo lives. Two years of maintenance therapy costs $22,000.

"They [province] want me to go to the hospital and die and be useless, knowing there is a drug that can help me," said Mr. Arevalo, 48.

Most provinces prohibit hospitals from infusing unfunded intravenous drugs into patients who have purchased them, which is seen as a violation of the Canada Health Act because it could be deemed payment for a medically necessary service.

For more than four months, the Ontario government has been reviewing a proposal by Cancer Care Ontario that suggested patients be allowed to buy drugs not covered by the province and have medicines infused in hospital for a fee, from $250 a visit up to $2,500.

Terrence Sullivan, president and chief executive officer of Cancer Care Ontario, said the proposal came out of concerns about patient access to drugs and continuity of care.

"We are trying to build a system of integrated care for cancer patients," he said yesterday. "That is why the whole idea of considering these [drug] agents seemed, in our view, a sensible and desirable alternative."

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