A Canadian charity is criticizing the B.C. government for choosing not to approve or fund dozens of medications people with rare diseases rely on and can receive elsewhere in the country for free.
In a report released in January, the Gastrointestinal Society compared B.C.’s public coverage of certain drugs to other provinces. It found B.C. rejected about 30 medications between 2018 and 2023 that almost every other region approved. Each had been endorsed federally by Health Canada and recommended nationally by the Common Drug Review, but did not pass B.C.’s own review process.
The result of such decisions is a provincial system that covers far fewer drugs and spends significantly less per person on drug coverage than most other parts of Canada.
Gail Attara, the CEO of the Gastrointestinal Society, said B.C.’s approach has mystified and frustrated her. Her conclusion, she said, is that B.C.’s process simply isn’t “patient-friendly.”
“They’re not looking at the uniqueness of the individual.”
The medications B.C. hasn’t approved would, in many cases, only be used by a very small fraction of people. Some help treat extremely rare conditions, such as short-bowel syndrome. Others are for more common conditions, such as acne vulgaris or plaque psoriasis, that people could turn to if other options haven’t worked. But, Attara said, just because a medication would only work for a small percentage of people, doesn’t mean it shouldn’t be an option.
As the head of the Gastrointestinal Society, she’s particularly interested in short-bowel syndrome, a disorder that makes it impossible for patients to absorb proper nutrients through their intestines. People who suffer from it have to follow a specialized diet and often rely on nutrients delivered intravenously.
One medication that has been shown to increase intestinal absorption and reduce intravenousreliance is teduglutide. It’s been approved for coverage by every province except Prince Edward Island and B.C., where it was rejected in 2017. The B.C. Ministry of Health said in its decision then that the drug had an “uncertain clinical benefit” and wasn’t “cost effective.”
The ministry declined an interview request, but told Black Press Media teduglutide is again under review. It also noted two of the medications listed in the Gastrointestinal Society’s report receive limited coverage, one receives full or partial coverage in exceptional cases, and another is under review.
Compared to most provinces, B.C.’s drug coverage is also more universal. Some degree of reimbursement is available to everyone based on income, whereas in certain parts of Canada only elderly or extremely low-income residents qualify.
Still, both the number of medications covered in B.C. and the amount the province spends on drug coverage per year is significantly lower than other places.
B.C.’s latest PharmaCare trends report shows the province covered 1,132 types of drugs in 2021/2022. By comparison, Quebec covered more than 8,000 and Alberta and Ontario each covered around 5,000, according to their respective government websites.
Data from the Canadian Institute for Health Information further shows that, despite B.C. spending above the national average on overall health expenditures per person, it devotes the least amount of any province to drug coverage. For 2023, CIHI forecasted that B.C. spent $257 per person on drugs, while the average across Canada was $442.
Figures from an Office of the Parliamentary Budget Officer report also reveal that British Columbians are footing the majority of non-hospital drug costs themselves, either by paying out-of-pocket or through private insurance. Just 35 per cent of costs are being covered by the province, compared to the Canadian average of 46 per cent.
Asked about the issue at a cancer care announcement in Nanaimo on April 16, Health Minister Adrian Dix said B.C. uses an evidence-based approach and has “excellent coverage.”
“Different provinces have different processes, but ours focuses on ensuring that people who need drugs get access to that.”
Attara said she is hearing something different from patients, though. She said she knows of at least one family with a child suffering from short-bowel syndrome considering moving provinces to access teduglutide medication.
“You know, they’re not just numbers out there. They’re people living a life – a unique life and a tragic life.”
Attara said she respects that approving new medications needs to be a rigorous process, but that she hopes B.C. will begin aligning itself more closely with other parts of Canada.
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