Crohn's disease and ulcerative colitis, the two main types of inflammatory bowel disease (IBD), are lifelong debilitating medical conditions with no cures. One in 150 Canadians has Crohn's or colitis, and each person's experience living with it is unique and individual.
Unfortunately, it can take someone up to two years from the onset of symptoms to be properly diagnosed. Then, it can take years and multiple rounds of trial and error before landing on an effective treatment that offers stability and the ability to live a normal life.
"To ensure the best possible health outcomes, we believe doctors and patients across Canada should have access to all medications approved for use in patients living with Crohn's or colitis," says Mina Mawani, president and CEO of Crohn's and Colitis Canada. Once a patient has found a successful treatment, they should not be forced to abandon it due to cost alone."
To protect doctor-patient decision-making, Crohn's and Colitis Canada developed the No Forced Switch campaign. Its goal is to educate and influence elected provincial policy-makers to adopt a policy ensuring IBD patients, who are currently stable on a treatment – and who are dependent on a province's drug program – are not forced to switch to a lower-cost alternative and lose the stability they have achieved.
"Crohn's and Colitis Canada fully supports safe, effective and lower-cost treatment options like biosimilars. However, when evaluating medication costs, there are a number of factors to consider and optimal patient care should be paramount. In some cases, decisions impacting a person's health are being taken away from patients and doctors through a forced medication switch," adds Mawani.
Unlike conventional generic medications, biosimilars are not identical to their innovator biologic. Minor variations in manufacturing processes between a biosimilar and its innovator biologic can result in unpredictable effects on patients.
"It concerns us that the governments are making decisions about a person's health based simply on the cost of the medication, rather than what the person's physician thinks is necessary."
- Gail Attara
is president and CEO of the Gastrointestinal Society
"We developed this campaign because our patient community is concerned there isn't enough evidence to demonstrate that switching a patient won't result in loss of treatment response. Switching may also mean losing elements of the patient support program, which plays an important role in the treatment process. There are a limited number of available treatments and we strongly believe we need to expand, not reduce, the list of available therapies," says Mawani.
Access to IBD treatments varies across Canada, which means many patients can't get necessary medication because their province or territory does not cover it. To illustrate the wide inequality, the Gastrointestinal Society developed an IBD Report Card, which assesses and grades the various public payor jurisdictions (provincial, territorial, and federal) as to which approved medications they cover for their patient populations that have IBD.
"Some provinces are no longer covering the innovator biologics, which means stable patients will be forced to switch to biosimilars, which are not identical drugs, against the prescribing advice of their own physicians," explains Gail Attara, president and CEO of the Gastrointestinal Society. Some jurisdictions also have stricter eligibility criteria, so patients have to take medications that could potentially harm or delay making them well, and some public payors offer no coverage for biologic medications at all."
The impact of IBD and the patient's day-to-day considerations are largely unknown to policy makers. Providing this context underscores the importance of expanding access to treatments that lead to patient stability.
"It concerns us that the governments are making decisions about a person's health based simply on the cost of the medication, rather than what the person's physician thinks is necessary," Attara adds.
To get involved, learn more about the No Forced Switch campaign and send a letter to your MPP, MLA or provincial minister of health visit action.crohnsandcolitis.ca.
To see your province or territory’s grade in the IBD Report Card and learn what you can do locally to help your voice be heard, visit badgut.org.
This content was produced by Randall Anthony Communications, in partnership with The Globe and Mail's advertising department. The Globe's editorial department was not involved in its creation.