One of the most difficult parts of formulating a response to the fairness letter in my particular case was even determining what the actual costs are to the Canadian Government. It took me a while to find a source for such information, but it turns out that the Government of Quebec publishes a complete list of what they are willing to pay; my understanding is that this in turn is based upon the actual negotiated prices of the Canadian Government. The liste de médicaments provides exactly this information.
By using this information I have been able to find what would be the least expensive option for treating an HIV infection in Canada at the present time. While not the “preferred first line” treatment, it is still listed as a valid first line treatment and thus should be an option for anyone arguing the fairness letter.
Specifically, the combination of lamivudine, zidovudine and nevirapine (also known as Combivir and Viramune) now involves two drugs that are off patent (zidovudine and nevirapine) in Canada as well as the third (lamivudine) for which the patent expires June 2, 2012 (it is already off patent in the United States).
The current cost (as I write this) according to the Quebec price list is:
Zidovudine (100mg x 3) twice per day = $6.32/day
Lamivudine 150 mg twice per day = $9.30/day
Nevirapine 200mg twice per day = $2.47/day
Total cost per day = $18.09/day
$542.70 per month. At $6,512.40 per year, this is above the maximum allowed, albeit only slightly over that limit. With the impending generic status of Lamivudine, I would expect those prices to fall so they are below the threshold.
For a comparison, I used an online Canadian pharmacy (based in Quebec) to determine the price of generic equivalents.(Canadian Family Pharmacy – Your Cart)
It is a bit of a challenge to put this all together cleanly, but let’s go through the math:
Zidovudine is $4.56/day
Lamivudine is $2.00/day
Nevirapine is $3.40/day
Total per day: $9.96.
That’s $298.80 per month for this treatment option. I did not combine the first two drugs together because that combination is covered by a patent still (“Combivir”) that has not yet expired. However, my point is that all of these drugs are available as generics staring June 2, 2012. This is a Canadian based company selling these drugs. Note that this company will not ship products to Canada. This is due to the Canadian rules that these drugs may not be imported (they are “Schedule F”) but for the purposes of computing the cost of generics, this is a reasonable place to start – if the government wishes to disagree, they can but they would need to be in a position to explain how they reached their conclusion.
Bottom line: if you find yourself arguing against a fairness letter due to your HIV positive status, obtain a letter from your doctor indicating that this combination is an acceptable starting therapy for you. Then use this cost analysis to point out that the total cost of treatment is now under $3600 per year. Even with periodic testing, your total costs will be well under the current limit (just over $6000 per year).
I didn’t make this argument because the emphasis by CIC in the past was on insurance. Their response to me was “your insurance doesn’t matter, all that matters is the total cost of treatment, which is paid for by the provincial government”. If I had known insurance didn’t matter, I’d have focused on costs. Hopefully, if you find yourself in the same situation you can avail yourself of this argument.