Blood-disorder drug Soliris to receive limited PharmaCare coverage in B.C.

The B.C. government has joined four other Canadian provinces in agreeing to publicly fund – in exceptional circumstances – one of the world's most expensive drugs. But Health Minister Adrian Dix blasted the manufacturer of Soliris and said the province will join in a legal action over the $700,000-a-year price tag.

"The health of our public drug plans, and our ability to help patients and families, is dependent on us working together to hold companies such as Alexion [Pharmaceuticals Inc.] accountable for the outrageous prices they set," Mr. Dix told reporters at a news conference. "Decisions such as this have significant cost implications that affect our ability to support all patients in British Columbia."

Drugs for ultrarare diseases are a growing – and lucrative – share of the international pharmaceutical market. Over the past decade, Connecticut-based Alexion Pharmaceuticals has posted steadily increasing revenues from the sale of Soliris: In the first nine months of this year, the company earned $2.4-billion (U.S.) from sales of this one drug, even though only about 10,000 people suffer from either of two rare and life-threatening blood diseases for which it is used.

Soliris is prescribed for atypical hemolytic uremic dyndrome (aHUS), a genetic disorder characterized by blood clots in small vessels, and for paroxysmal nocturnal hemoglobinuria (PNH), which causes blood clots and destroys red blood cells.

In September, Canada's drug-pricing regulator ordered Alexion to roll back "excessive" prices for Soliris. The company has sought a judicial review of the decision, and Mr. Dix said the B.C. government will seek intervenor status.

By allowing some public coverage for Soliris prescriptions, Mr. Dix, who became Health Minister in July, is overturning a policy of the former BC Liberal government. He defended that earlier decision, saying it was only after a review of the other Canadian provinces that fund the drug – Ontario, Alberta, Saskatchewan and Manitoba – that he agreed to allow limited coverage for people with aHUS.

In Alberta last year, 18 patients got Soliris at a cost of more than $6-million.

Mr. Dix would not speculate on how many people may be eligible in B.C., but it is expected that only a handful would qualify. A panel of medical experts will evaluate requests on a case-by-case basis.

But Mr. Dix noted that providing just a single patient with Soliris will cost PharmaCare $3.5-million over five years.

The B.C. government's PharmaCare program for prescription drugs has run a deficit for the past three years, and ministry officials say expenditures have increased mostly due to expensive medications for conditions such as Hepatitis C, and rare diseases.

Mr. Dix said pressure to fund high-priced drugs for a few cases has to be balanced against the level of coverage that can be offered to a broad range of patients in the publicly funded program. "Some people with relatively low incomes pay very high deductibles for drug coverage in British Columbia," he said.

In a report earlier this month, the Canadian Institute for Health Information found that Canadians with drugs costs of $10,000 or more annually represented only 2 per cent of beneficiaries of public drug plans, but accounted for more than one-third of public drug spending in 2016.

The trend toward high-priced drugs claiming a greater share of public drug expenditures is growing. According to analysis from the Patent Medicines Price Review Board, only 14 drugs available in Canada had an annual cost of more than $10,000 in 2005. A decade later, 124 drugs available here cost more than $10,000 a year – and 20 of them cost more than $50,000 a year.

For two years after Ontario agreed to fund Soliris, British Columbia balked at covering it, citing independent experts from the national Common Drug Review and B.C.'s Drug Benefit Council, who found no clear-cut clinical benefits to justify the high cost.

However, after a public battle for coverage by some patients, Mr. Dix ordered a review, and changed the policy late last week: The drug can now be covered under B.C.'s Pharmacare prescription program for some aHUS patients who meet strict criteria.

The doctors of patients seeking coverage in B.C. will have to apply to the expert panel, and the treatment will be reviewed after six months and again after one year.

With Soliris on the list, British Columbia now has 15 drugs that are subject to approval by the panel.