In my previous post about prescription drug coverage in British Columbia I did not really go into detail about the evidence supporting my argument that the province does not cover drug costs for HIV specifically.
In this post I’d like to rectify this oversight.
First, each province has a governmental website dedicated to explaining the coverage provided by provincial health care. In BC, it is Fair PharmaCare that provides coverage for some prescription medications. The BC website includes a drug formulary that describes the drugs covered by the provincial plan. British Columbia has a separate panel that actually reviews drug information as part of the process of being added to this formulary and after careful scrutiny recently that program has been renewed. While I did not check every single drug for HIV available, I checked those that are commonly prescribed (e.g., tenofovir, efavirenz, raltegravir, ritonavir) and the once-per-day treatment options (Atripla, Complera, and Stribild). None of them are listed in their formulary. Further, that formulary explicity states that they do not describe drugs covered by the BC Centre for Excellence in HIV/AIDS. This group is a non-governmental research group with funding from a variety of sources, including the provincial government. The web page for the therapeutic care given explicitly states:
The Drug Treatment Program (DTP) is an innovative research and treatment program designed to ensure that all medically eligible persons living with HIV in British Columbia have access to free antiretroviral therapy.
Established in 1992, the DTP currently provides nearly 5,500 patients with access to life-saving drugs.
One of the foundational programs of the BC-CfE, the Drug Treatment Program is funded by the provincial government (PharmaCare) to distribute anti-HIV drugs based on guidelines generated by the Therapeutic Guidelines Committee. Information from all participants is entered into a database, providing data for clinical and virological outcome studies of patients receiving antiretroviral therapy. This database acts as a registry of all HIV-treating physicians in the province, as well as an “early warning system” to alert government about the trajectory of the disease.
Thus, the data from patients working through this program is used to further the research goals of this group. While one could claim (as CIC does) that this constitutes “free drugs” in fact it does so for the express purpose of using the participants as guinea pigs in the research being done by this organization.
Further, this group limits the therapeutic options that are available to participants. In this published list a surprising number of drugs listed are subject to restrictions. For example, my own doctor said the therapeutic option he recommended would not be approved by the Centre for Excellence – and normally he can’t prescribe this specific therapy precisely because it won’t be approved. When I looked at that list, all but one of the drugs he prescribed to me are listed as “Certain restrictions apply”.
So “free” can also mean “therapeutic options in the best interests of the research group, not the patient”. That’s the nature of a research study – it’s primary focus is in collecting information about the subject under study. But I suspect most patients want to pick the best therapeutic option for them personally, not the one that forwards the interests of a research study or group. Of course, some people do choose to enroll in research studies (e.g., clinical trials) in exchange for something: lower costs, otherwise unavailable therapeutic options, etc.
As an aside, notice that all the Centre for Excellence web pages are actually maintained by the University of British Columbia. While that’s a public educational institution, it’s not one that is generally associated with the provincial health care system and operates as an independent organization.
So, for anyone else facing this situation in the future, do your homework. Regardless of the province where you intend on landing, don’t assume that the medical officer knows the provincial rules. It’s quite possible that he or she is just making it up, based upon her or his own misconceptions. For example, in my case the medical officer stated:
This applicant’s medical condition is likely to require treatment that is expensive and publicly funded in B.C. Although he has private insurance, antiretroviral medications are covered 100% by the provincial drug plan in the Province of Britsh Columbia with no payment from private insurance.
She completely misunderstood the BC plan. It isn’t funded by the provincial drug plan directly. It’s funded indirectly through a research study: you must accept loss of privacy and you must be willing to accept treatment options that advance the research effort and are not necessarily the best options for you as a patient. In my case I had private insurance to cover the best therapeutic option. Why would I choose an option that wasn’t best for me?
From my interactions with others caught in this quagmire of excessive demand, it really does seem clear to me that it’s more about reinforcing biases against people with disabilities, despite Canada’s obligations to the contrary. Ah, but that’s topic for another blog post.