Provincial reimbursement decisions: how long is too long?

Earlier this week we were proud to have our work profiled in the Canadian Cancer Advocacy Coalition’s Report Card on Cancer.  Our article titled “Patient Organizations Cautiously Optimistic with New pCODR Process” outlined how patient advocacy groups can be involved in the oncology drug review process — and how we at Kidney Cancer Canada had surveyed patients and caregivers and submitted an in-depth Patient Evidence Submission. To read our article, click here.

While we have been happy with the pCODR process to date, we are not entirely pleased with the speed of  provincial implementation. Each province decides whether to adopt the pCODR recommendation. We’re not sure who is tracking the provincial decisions, but we’re keeping track for the first drug, pazopanib (Votrient) for kidney cancer.

How Long is Too Long?

Most drugs are approved first in the U.S. (FDA), and then usually Health Canada approval follows approximately 6 months later.

June 2010: Health Canada approved pazopanib in metastatic renal cell carcinoma.

July 2011: After some delays in getting started, the pCODR process began and we were asked to submit our Patient Evidence Submission. We put in an estimated 60 hours of volunteer time reviewing our patient survey results and making sure our submission met the requirements.

December 2011: The pCODR Final Recommendation is posted. (In total, 18 months after Health Canada approval).

So, How Many Provinces Have Adoped the pCODR Recommendation?

We need to exclude two provinces: Quebec (because Quebec has its own drug review that has approved pazopanib) and British Columbia (that does participate, but announced reimbursement for pazopanib ahead of the pCODR recommendation due to prior budgeting and analysis).

Of those provinces waiting for the pCODR recommendation, only three have issues provincial decisions to reimburse the cost (in following with the pCODR recommendation). Those provinces are: Alberta, Saskatchewan, and Newfoundland and Labrador.

The real “proof” of whether pCODR makes an impact will be in how quickly the other provinces follow suit. We are still anxiously waiting for decisions from Ontario, Manitoba, New Brunswick, Nova Scotia, and PEI.  If those provinces continue to study the pCODR recommendation, we will not have achieved any consistency in access for patients. (We are now 22 months post Health Canada approval.)

Time is Running Out!

Patients across Canada have been able to access pazopanib through a Patient Access Program — a program usually designed to allow the formal reimbursement processes to take place. That program will come to an end (will not enroll any new patients) on May 31, 2012. So, we have six weeks to hear from Ontario, Manitoba, New Brunswick, Nova Scotia, and PEI.

We are still cautiously optimistic, but the timeline from Health Canada approval of a new cancer drug to that drug being accessible in each province is far too long.  While provincial delays may save money by deferring costs, patients cannot wait an additional two years beyond the many years it takes to bring an innovative drug to market in the first place. We need for pCODR to lead to more efficiency at the provincial level — and to more consistency in access to cancer drugs across Canada.

If patient groups are going to have to go from province to province waging a battle for access (again), what is the benefit of our new pan-Canadian drug review process?




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