Ottawa Sun
Published: Wednesday, September 16, 2009

Addressing cancer care: Access to treatment based on where you live wrong and must be stopped

While our American friends continue to debate the Obama-care reforms to health insurance -- some modeled on our system here in Canada -- a new report from the Canadian Cancer Society shows that when it comes to our access to cancer drugs, universality is not even remotely in the realm of the possible at the moment.

Released Monday -- and no doubt timed to coincide with the provincial and territorial health ministers meeting taking place tomorrow and Friday in Winnipeg -- the society's report paints a disturbing picture of varying degrees of access (and often, denial of access) to life-saving and life-extending cancer drugs.

In a nutshell, if you're a cancer patient in need of an innovative therapy prescribed by your oncologist to shrink a tumour before surgery, to deal with a side-effect of another medication or simply manage and retard the progression of a specific cancer, well, your postal code is probably the most important determining factor of whether you will get the drug and how much it will ultimately cost you.

Compared to our OECD peers, in general, Canadians have less access to innovative medicines across most therapeutic areas. Cancer is no exception. On the plus side, more and more cancers can be cured or managed as a chronic disease. And pharmaceuticals have become the standard method in how millions of cancer patients manage their disease, daily, weekly and yearly.

But here's the rub. When cancer drugs, like most other medical conditions, are administered outside of the hospital setting, they fall outside the fabled (wrongly so by the way) Canada Health Act. It falls to the provincial drug plan and/or private insurers to foot the bill. This is where the pain for many cancer patients and their families is magnified.

To start, there are 19 public insurance plans in Canada and dozens of private plans, all with different rules as to what gets covered and by how much.

For example, your chances of getting covered for most cancer drugs are better in British Columbia than in Ontario. And B.C. also lists more cancer drugs for public reimbursement than other provinces and their survival rates are the best. Hmm, anybody see a correlation here? But I digress.

If you are fortunate to have private insurance to supplement your public coverage, your specific plan has its own varying rules. But co-payments from some drug plans are as high as 20% and most also institute a hard cap. The result is many families undergo severe hardship to keep their kin alive and those from lower-income groups with no plans and limited provincial coverage might forgo necessary and live-saving treatment.

In fairness, all provinces (except Quebec) are participating in the Joint Oncology Drug Review to reduce interprovincial disparities between public and private drug coverage. This initiative is far from perfect since some provincial cancer agencies are recommending drug treatment guidelines for cancer drugs while their drug reimbursement plans don't cover the drug or drugs in question.

This is a national issue that deserves leadership from our politicians, private insurers and industry in a creative dialogue with a simple goal: Make Canada the global leader in cancer drug access.