The gross and ever-widening disparities in the coverage of cancer drugs is causing widespread financial hardship and undermining medicare, the Canadian Cancer Society warns in a stinging new report.
Due to a patchwork system and an "impenetrable level of complexity" in how drugs are approved and reimbursed, many cancer patients are facing burdensome costs and intolerable stress, the group says in calling for a nationwide catastrophic drug plan.
"The last thing you need as a cancer patient is to worry about your drug costs," Dan Demers, director of public issues at the CCS, said in an interview. "What we're seeing is the erosion of universal health care."
The 39-page report, entitled Cancer Drug Access for Canadians, reveals some staggering statistics: A combined $1.1-billion was spent on cancer drugs last year, and one in 12 Canadians face catastrophic drug costs - defined as greater than 3 per cent of net household income.
Even workers with private insurance face co-payments of up to 20 per cent of the cost of cancer drug as well as caps on how much the plans will reimburse.
When Joan Gaudet of Tignish, PEI, was diagnosed with kidney cancer 12 years ago, she had surgery to remove her diseased kidney. But the cancer returned in November of last year.
Renal cell carcinoma cannot be treated effectively with either chemotherapy or radiation, so Ms. Gaudet was prescribed a drug called sunitibib malate (brand name Sutent).
One month of pills cost $7,445, far beyond the means of a retired school-bus driver whose annual income was less than $20,000.
"Mom just buried her face in her hands and cried. It was devastating news," her daughter Traci Gaudet said in an interview.
"In Canada, you just assume that if you get sick, they will take care of you. It was a shocking thing for a decent, hard-working, down-home woman to learn that medicare wasn't there for her when she needed it."
The senior Ms. Gaudet, 73, got the treatment because her children and grandchildren pooled their resources and paid for the drugs out-of-pocket.
Faced with remortgaging their homes and cashing in their RRSPs to continue to pay for the cancer drugs, the family also started a relentless letter-writing campaign, lobbying provincial politicians to change the rules - and the pressure worked.
The family paid for the $7,445 prescription three times (with assistance from a community fundraiser). But when Ms. Gaudet filled her fourth prescription, the cost was $30.
In response to the family's lobbying, the PEI government agreed to cover Sutent. If Ms. Gaudet was not a senior, she still would not have had the drug paid.
"We were grateful for the change, but I'm not sure the province has learned its lesson," Traci Gaudet said. "Funding is still on a case-by-case basis and that's not how it should be. All Canadians should be equal."
That is precisely the position of the Canadian Cancer Society, which is demanding a national catastrophic drug plan, which would mean government would pay once drug costs exceed an established threshold.
The group is holding a symposium on cancer drug access Tuesday in Ottawa and calling on provincial and territorial health ministers to place the issue at the top of their agenda when they meet in Winnipeg later this week.
The irony of the system is that all provinces and territories have endorsed, in principle, the idea of a catastrophic drug plan. Eight provinces even have a form of catastrophic drug plan already, though there are significant differences. Ideally, they would like a national formula to ensure that all patients face similar rules regardless of where they live. But doing so would almost certainly require Ottawa to kick in significant funds.
"The role of the federal government here is to show some leadership and to ensure that access is equitable," Mr. Demers said.
He also noted that, while the new report focuses on cancer drugs, the same disparities and problems exist for patients with all sorts of chronic conditions such as cardiovascular disease, diabetes and lung disease.
Last year, an estimated 166,400 Canadians were diagnosed with cancer and about 73,800 died.
About 40 per cent of women and 45 per cent of men will develop cancer during their lifetimes, and about one in four Canadians can expect to die of cancer.
TROUBLING STATISTICS
The Canadian Cancer Society's report on access to cancer drugs highlights a number of troubling issues:
- A combined $1.1-billion was spent on cancer drugs last year;
- One in 12 Canadians faces catastrophic drug costs - defined as greater than 3 per cent of net household income;
- The average cost of treatment with newer cancer drugs is now $65,000;
- Half of new cancer drugs are now taken at home, where they are not necessarily covered by medicare (which guarantees coverage for hospital and physician treatment);
- Cancer drugs are 100-per-cent covered in only three provinces (B.C., Alberta, Saskatchewan) and two territories (Nunavut and NWT);
- For most Canadians, being insured (in a private or public plan) does not guarantee that a cancer drug prescribed by their oncologist will be covered;
- While every province and territory has a drug plan for seniors and social-assistance recipients, even they can face significant out-of-pocket expenses for costly cancer drugs.
André Picard