Release: Medicine Rationing is Wrong for Ontarians
FOR IMMEDIATE RELEASE
April 6, 2005
Medicine Rationing is Wrong for Ontarians
Patient health is at risk
TORONTO, ON (Wednesday, April 6th, 2005) - Groups representing seniors and patients told MPPs this morning that restrictive drug pricing schemes are bad news for Ontarians.
The Ministry of Health and Long Term Care recently confirmed the province is considering ways to reduce spending in the Ontario Drug Benefit (ODB) program by adopting a plan like one already in place in British Columbia. Under these drug-pricing models, the government - not the doctor - decides which prescription medicines a patient may receive if they are covered under the ODB program.
Groups such as the Canadian Society of Intestinal Research (CSIR), Canada's Association for the Fifty-Plus (CARP), the Canadian Treatment Action Council (CTAC) and the Best Medicines Coalition are warning the Ontario government that such plans are more costly in the long run and put patient health at risk.
Such a plan would see those whose prescriptions are covered by the ODB program eligible to receive coverage for only those medications designated by the plan, usually the cheapest. The patient would then have to pay the cost difference or even the cost of the entire prescription. In effect, they lose their coverage if they use any medication other than the government-designated one.
"These policies should outrage Ontarians," says Gail Attara, Executive Director of the Canadian Society of Intestinal Research and member of the Best Medicines Coalition. "All patients are unique and no one drug will work the same for everyone. A patient may not be able to get the medication their doctor decides is best for them after considering their unique medical history and the full range of medications available in Canada. The doctors role in patient care is undermined and patients suffer."
"This practice is not supported by scientific evidence. It is not generic substitution, where you are getting the same (patented-expired) chemical, but it is where a different, patented, unique drug with a somewhat similar performance is substituted in place of the one your doctor has prescribed for you," Attara added.
"Forcing a select group of patients - such as seniors, disabled people and the poor - to switch medications due to personal financial constraints is wrong and can lead to potentially serious medical problems," says Lillian Morgenthau, President of CARP.
According to a recent survey by CARP, 86 per cent of Ontarians are unfamiliar with the concept of reference-based pricing on an unprompted basis. Of the 14 per cent who expressed some level of familiarity, less than 5 per cent were able to correctly describe the policy. Additionally, almost three-quarters of those surveyed were opposed to this type of policy given that the Ontario government has not publicly consulted with Ontarians, seniors, and other key groups who would be affected by this policy.
Pricing Policies are Short-term and Short-sighted Solutions
"I was stable on a medication to treat severe reflux disease for many years, then I was forced to switch my medication and I became very sick, very quickly," says Claudia Roberts, a British Columbia patient who was forced to switch her medications under the therapeutic substitution policy in place in the province. When patients fail on the cheapest drug, there are greater costs to other areas of the healthcare system, for example, increased doctor visits, hospital visits, and diagnostic testing. All of this results in higher overall costs to the healthcare system.
"We want to let the Ontario government know that they don't have the whole story on the severe restrictions in BC, a model they seem willing to import far too quickly," said Attara. "The Ontario government would be wise to avoid the mistakes made in BC. A good place to start is to take heed from those living the experience."
"We recognize that cost-effectiveness is important, but consider cost-containment policies pennywise and pound-foolish," said Louise Binder, Chair of CTAC and member of the Best Medicines Coalition. "The Ontario government may be saving a penny or two now with these cost-containment schemes, but they will pay a lot more later as the financial burden is shifted to other areas of the healthcare system."
Patients and Seniors Must be Heard
"We encourage the government of Ontario to reject any plan that includes medicine rationing schemes," says Morgenthau. "We also urge the government to be more transparent about its intentions and engage in meaningful consultation before proceeding any further. It frightens me that instead of a doctor, some bureaucrat would decide what the best medication for a patient should be. It doesn't make medical sense and it certainly doesn't make financial sense."
"Only physicians in consultation with the patient are in the position to determine optimal care - not governments," she said. "And to achieve optimal care, physicians need choice, not limits."
Patients and Seniors Offer Alternative Solutions
Medicine rationing is clearly not the best and not the only option in meeting patients needs when it comes to medications. Other, patient-focused, options are available to assist the Government of Ontario in meeting its challenge. These include educational programs and partnerships to assist patients in using their medications as prescribed; encouraging overall wellness (diet, exercise, and smoking cessation) as a means of disease prevention; educational partnerships with health care professionals that encourage appropriate use of medications, and fully integrated patient health management programs.
BACKGROUNDER: MEDICINE RATIONING
Medicine Rationing
Medicine rationing is based on the assumption that all drugs within a given class of medications deliver the same benefit for every patient. Because all drugs in a class are deemed to deliver the same benefit, the government only allows Ontario Drug Benefit Program recipients to receive medication costing a set amount, based on the pre-determined schedule, equivalent to the cheapest medication in the class. This assumption of ’equality’ is not evidence-based. To receive a patent in Canada, drug manufacturers must prove their product is unique.
Reference-Based Pricing (RBP)
The government establishes a single, low price - the reference price - that it is prepared to pay for a given class of drugs. If a physician prescribes one of the drugs in that class that is higher in cost than the reference price, then the patient has to pay either the difference in price or the entire cost of the prescription. This type of rationing is sometimes called lowest cost alternative pricing.
Therapeutic Substitution (TS)
In order for a patient to be reimbursed for their medicine, their physician may only prescribe the government-approved, lowest-priced drug in the class. The physician is free to prescribe any drug, but if it is not the drug named by the provincial plan, then the patient must pay the entire cost of the prescription. If the designated medicine prescribed does not work or the patient has a bad reaction, the physician may, after a prescribed trial period, apply to the government for an exemption. In some cases, no exemption is allowed.
Maximum Allowable Cost (MAC)
The government establishes a single, low price - the maximum allowable cost - that it is prepared to pay for a given class of drugs. If a physician prescribes one of the drugs in that class that is higher in cost than the maximum allowable cost, then the patient pays the difference. Medicines priced lower than the set price would be covered by the plan.
Generic Substitution
When any given drug patent expires, the chemical may be manufactured and sold under a ’generic’ label. In most cases, the medication is identical to the patented product. This is not what is under discussion at this time in Ontario.
Who is covered by the Ontario Drug Benefit (ODB) Program?
- Seniors - people 65 years of age and older
- Social assistance recipients
- people on welfare and disabled people, and their children
- Trillium Drug Program recipients
- people who have high drug costs in relation to their income
- Residents of long-term care facilities
- Residents of Homes for Special Care
- People receiving professional services under the Home Care program