Therapeutic Substitution

Vancouver, BC – February 8, 2005 – Pressures on healthcare and drug benefit plan managers are prohibitive. We all know that cost-saving measures are necessary. However, in the zeal to chop excess funds from budgets, plan managers must not lose sight of the very reason such plans exist, to help patients, by providing reasonable access to medications, not harm them! When an economic decision has serious medical repercussions, it must be reconsidered, and changed. So, why then, is this kind of restrictive policy creeping into the fabric of Canadian life?

Therapeutic Substitution is a bizarre situation where the government, not a doctor, forces patients to substitute one medication for another. The government (via the drug benefit plan) decides which medication someone must take for a specific illness. Therapeutic substitution takes reference-based pricing to another level. It is not generic substitution either, but preference by the government to provide reimbursement for one brand name product over another.

As we have reported previously, in this particular case, the first of its kind in Canada, it concerns the proton pump inhibitor (PPI) class of medications, used for the treatment of gastroesophageal reflux disease. Even though Health Canada does not call these drugs equivalent, the BC PharmaCare program has made a serious policy decision that has negatively affected thousands of patients. Here are the BC results…

When the therapeutic substitution policy was launched in July 2003, 53,000 existing PPI users were identified and then notified that they would be forced to switch to the cheapest brand name PPI the next time their prescriptions needed to be refilled. All new patients requiring a PPI in BC were also forced to use the cheapest brand name PPI.

During the first six months of the policy implementation, of the 68,000 (53,000 pre-existing and 15,000 new) total patients identified to use the cheapest brand name PPI, there were 39,000 prescriptions filled. (Presumably, some prescriptions had not yet been renewed.) We were appalled to learn that 9,600 of these individuals (24.6%) had to stop taking the cheapest brand name PPI due to treatment failure. Treatment failure is harmful for patients, especially for those who had been stabilized on a different PPI!

BC PharmaCare’s forced therapeutic substitution policy has resulted in higher healthcare costs due to increased doctor visits, increased hospital utilization, increased diagnostic testing, increased workload of doctors and pharmacists, and increased bureaucracy for healthcare and government officials.

Why would the PharmaCare program continue to enforce such a policy? And why would other governments consider doing the same thing to the people in their provinces? Newfoundland has announced that they will follow the BC model as of June 1, 2005. We have heard that Ontario is considering many options to cut its drug budget including policies currently in place in BC.

Patients are encouraged to ask their political representatives to put people first, and to look at the many alternative cost-saving solutions that consider the big picture without harming patients.

For more information please contact: Gail Attara – 604-873-4876