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Canada’S Drug Mythology
Labyrinth up north.


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Consider what drove New Brunswick’s Bill and Mary Cooper (names changed to protect privacy) to head south to the U.S. for treatment of their Type II Diabetes. Bill discovered Glucophage XR was the most-effective drug, but it wasn’t available under his provincial health plan. Mary, his wife, was doing well on Avandia. But when she switched from private pay to the provincial health plan, she was forced to start taking older medications even though they posed a risk of hypoglycemia and weight gain of 10 to 15 pounds.

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The switch saved New Brunswick $.90 a day. The costs to Bill and Mary and countless other Canadians–in inconvenience and in health complications–are much higher indeed.

Those for hopping buses to Canada for discount drugs ought to talk to patients like Bill and Mary. They would discover that the system that produces cheap Zocor comes with a severe side effect: It prevents Canadians from taking better, modern drugs.

“The new biologics are changing the course of arthritis,” says an excited Denis Morrice, CEO of Canada’s Arthritis Society and co-chair of Canada’s Best Medicines Coalition. Morrice is referring to drugs such as Enbrel and Remicade, which are effective in halting the progress of some of the most debilitating forms of arthritis. Americans have long enjoyed access to these medications. But in Canada, Morrice says, “Many people can’t get them.”

Canada’s drug regulatory system is labyrinth of hurdles. The prices at which drugs can be sold to wholesalers and pharmacies are strictly monitored by the Patented Medicines Prices Review Board. In addition, each of Canada’s 10 provinces maintains a government-approved formulary, which determines which drugs are available for Canadians who rely on public drug plans.

And among the biggest sticks is the national government’s threat to strip a drug company of its patent and allow generic companies, which bear no cost of research and development, the right to produce a drug if the patent-holding company fails to bring its products to market.

All of this means it takes much longer for new drugs to reach the Canadian consumer–and some never do.

It takes considerable time for cutting-edge medications to make it into the pillboxes of Canadians. One hundred new drugs were launched in the United States from 1997 through 1999: only 43 made it to market in Canada. Once approved by Canada’s FDA equivalent, they must be approved by each of the provincial formularies if they are to be available to Canadians who rely on the government as a payer for drugs. Many provinces approve fewer than half of the new drugs.

To save money, provincial officials delay the inclusion of new and sometimes more costly drugs.

“Let’s talk about human suffering,” says Morrice, who notes that four million Canadians suffer from some form of arthritis, the single largest cause of long-term disability in Canada. Asks Morrice, “Do you want to pay for the disability or allow people to have a quality of life?”

The problem cuts across diseases. “It takes twice as long to get AIDS drugs approved in Canada,” says Durhane Wong-Rieger, a prominent Canadian patient advocate. “And these are high-priority drugs.”

AIDS medication Reyataz, available in the U.S., hasn’t even begun the approval process in Canada. Pegasus, a drug that treats Hepatitis C, has been approved in the U.S. for three years, where it’s already available in a new and improved version. Canadians, however, still don’t have access to the original version.

For some drugs like Paxil Time Release, which treats depression, or Niaspan, which treats high cholesterol, patients can hop a bus South to pick up the pills. But Pegasus is delivered intravenously.

“I get patients who are not taking any drugs because they are waiting for this drug,” says Wong-Rieger. “Patients who are waiting are getting sicker. It’s a Catch-22. They can take the drug on the market and it won’t do the job, or they can wait and get sicker.”

Sally C. Pipes, a Canadian who lives in the U.S., is president & CEO of the California-based Pacific Research Institute.



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