Access to Medications

All Albertans should have equal, timely access to medications. Patient health outcomes can be improved by appropriate access to medication, particularly access to new, more effective drugs.

Canada has a multi-tiered approvals process that ensures medications are safe and effective, limits prices charged for medications and then further negotiates pricing and how a medication can be prescribed for publicly funded drug plans. However, physicians and patients must work together to develop effective treatment plans that inspire compliance and achieve health outcomes. Their choices should not be limited to funded options dictated by payers.

There are multiple publicly-funded drug plans in Alberta in place to ensure all citizens have access to medication coverage. However, according to a study published in Provincial Reimbursement Advisor, from Sept. 1, 2015 to Aug. 31, 2017 only 27% of newly approved medications were added to Alberta’s drug benefit list. Of those listings, 78% were given restricted status, thereby limiting patients and physicians’ treatment choices.

The Alberta Government’s public funding of medications must be transparent, protected and expanded, not reduced and constricted. Recent decisions reflect restrictive policies that move away from patient choice to government directed access and incentives to drive physician use vs. evidence.

Examples are:

• The Retina Anti-Vascular Endothelial Growth Factor Program for Intraocular Disease (RAPID) program encourages retinal eye specialists to use a first-line treatment option that is not approved as safe and effective by Health Canada when two approved choices are available. Prescription use is capped and physicians must redeem fees if limits are exceeded. There has not been any public reporting on health outcomes.
• The Biosimilars Initiative expansion restricts patients’ and physicians’ ability to maintain existing treatments with a mandated move to a biosimilar. The Health Coalition understands and values the role both originator and biosimilar biologics play in improving health outcomes. We welcome the diverse healthcare management options they provide. International examples demonstrate biosimilar uptake can be achieved voluntarily while maintaining patient and healthcare provider choice. While we applaud some of the components of Alberta’s Biosimilar Initiative, we believe more can be done to ensure patient confidence in their treatment:
• Patient education is an essential component in advance of any change in medication and must be more encompassing than a simple letter.
• Patients must have the ability to return to their originator biologic if there are signs of clinical change or failure within the first few months of a switch.
• The exemptions process needs to be a clearly defined, assessed by therapeutic area specialists and with consideration of patient perspectives.
• Alberta Health has projected this switch will realize savings between $227 million and $380 million once fully implemented. Other jurisdictions have designated a portion of these funds to direct care improvements for those disease states adopting biosimilar — cancer, rheumatology, etc. We encourage the Alberta Government to follow suit.

Recommendation:

1. A formal process for patient input into Alberta’s medication funding decisions needs to be developed. Provinces like British Columbia and Ontario have implemented an online submission portal for their residents to collect feedback and inform government decisions. Alberta needs to implement a similar system.
2. The patient perspective must contribute to the Biosimilars Initiative exemptions review process. The Health Coalition, with our diverse membership base, is an excellent representative to assess requests for exemptions from a societal perspective alongside the healthcare professionals’ medical opinion.
3. A portion of the savings achieved through the Biosimilars Initiative must be designated for direct patient care in impacted therapeutic areas.
4. We encourage the Government of Alberta to conduct patient and public consultations prior to any decision to participate in national pharmacare.
5. RAPID must be revamped to ensure patients have equal access to approved treatment options and are fully informed of alternate choices. Safety and efficacy data must be captured by all participating physicians and publicly reported to ensure appropriate care is provided.