Healthy Skepticism Library item: 13183

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Publication type: news

Silverman E.
Eyeing Coverage: Ontario Blinks Over Lucentis
Pharmalot 2008 Mar 14
http://www.pharmalot.com/2008/03/eyeing-coverage-ontario-blinks-over-lucentis/#more-12522

Full text:

In a surprise move, the Ontario government announced yesterday it will begin covering the cost of an expensive drug to treat macular degeneration, a leading cause of blindness, even though an alternative is widely available at a fraction of the cost, The Globe and Mail reports. (http://www.theglobeandmail.com/servlet/story/LAC.20080314.LEYE14/TPStory/TPEntertainment/Ontario/)

It will cost the province’s drug benefit plan roughly $100 million over the next three years to pay for Lucentis, a breakthrough drug that has been on the Canadian market since last September. The decision will give eligible Ontarians – primarily seniors – suffering from wet macular degeneration access to this new drug for the first time, the province’s Ministry of Health and Long-Term Care said in a statement. But the paper reports thousands of Canadians already have access to a similar drug that is much cheaper than Lucentis and that many ophthalmologists say is equally effective. That drug, Avastin, and Lucentis, are both made by Genentech.

The problem is that Avastin was developed to fight colorectal cancer and isn’t approved for use in the eye by Health Canada. Although many ophthalmologists in Canada regularly use Avastin to treat wet macular degeneration, the fact it doesn’t have government approval gives significant leverage to Novartis, which sells Lucentis in Canada, to lobby governments to fund the high-priced drug.

“It’s a very unusual situation,” said Keith Gordon, head of research at the Canadian National Institute for the Blind. The situation is similar to what took place in the US, which you can read about here.(http://www.pharmalot.com/2007/12/genentech-blinks-and-ends-avastin-restrictions/)

The Common Drug Review, a federal body that recommends whether provinces should pay for certain drugs, has already rejected one request to recommend coverage for Lucentis. Novartis has asked the body to reconsider the issue, and a final decision is expected later this month. Despite the existence of the CDR, provinces retain the freedom to decide whether certain drugs merit coverage.

Ontario decided to give Lucentis a priority review and approved its application because of the compelling evidence of its benefits, Helen Stevenson, assistant deputy minister and executive officer of Ontario public drug programs in the province’s health ministry, told the paper. Quebec is the only other province that has decided to cover Lucentis.

But some health-policy experts are criticizing Ontario for choosing to cover its cost despite the availability of Avastin. The decision will boost the drugmaker’s profits at the expense of Canadians, who stand to benefit more from a cost-effective solution, says Arthur Schafer, director of the University of Manitoba’s Centre for Professional and Applied Ethics.

“There’s no reason to prefer (Lucentis) to Avastin, aside from the fact it has been tested and approved,” he tells the paper. “Why would Canadian provinces be profligate in this matter, allowing the drug company really to suck out what will turn out to be tens or hundreds of millions of dollars from our health-care system?”

Instead of covering Lucentis, the government could fund research trials to examine Avastin, Alan Cassels, a drug policy researcher at the University of Victoria, tells the paper.

But that message may be lost on governments that hear compelling evidence from advocacy groups and patients, who often receive money from drugmakers to speak about a med, according to Schafer. For instance, Novartis provided money to the CNIB, in the form of an unrestricted educational grant, that is being used in part to fund its advocacy campaign supporting Lucentis. Novartis also has several paid ophthalmologists who promote the use of Lucentis.

But CNIB’s Gordon defended accepting the grants, saying the funding makes up less than 1 per cent of the association’s budget. “It really doesn’t influence what we do or how we do it,” he tells the paper. “Our reason for being involved in this is more than half our clients have” age-related macular degeneration.

Source: The Globe and Mail