Cancer Drug Coverage: Putting IV and Orally Administered Drugs on an Equal Footing. Deb Maskens Kidney Cancer Canada

Transcription

1 Cancer Drug Coverage: Putting IV and Orally Administered Drugs on an Equal Footing Deb Maskens Kidney Cancer Canada

2 The Coalition 30+ cancer groups Common issue: IV vs Oral Objective Reimbursement policy changes to make cancer treatment and support drugs (IV, oral and selfinjectable) available at no cost to cancer patients in Ontario and the Atlantic provinces.

3 Institutionalized Discrimination By: Age (Ontario >65) Cancer type (some rely more on oral medications) Formulation of drug (IV vs oral) Income (income testing on oral only) Home province (vs. ROC)

4 Tim & Jim LYMPHOMA mrcc ORAL IV INS $0 20% $14, % $72,000

5 Cancer Therapy is Changing... 60% of new cancer drugs = oral formulations Model of care shifting from hospital based acute care to outpatient chronic care. Employers face: Rapidly increasing cancer drug costs Province by province disparities in regards to employer born cancer costs

6 Employers Cancer Care Summit, 2012 This insurance deficit is a bomb out there, ready to explode. We have to get public and private parties together to address it. (Darwin Kealey, CACC)

7 Our Position A life is a life. Cancer is cancer. Cancer treatment and its financing, should be fair and equitable for all Canadians.

8 CanCertainty Coalition UNIFIED VOICE OF CANADIAN CANCER PATIENTS: APLASTIC ANEMIA ANDMYELODYSPLASIA ASSOCIATION OF CANADA (AAMAC) BLADDER CANCERCANADA BRAIN TUMOR FOUNDATION OF CANADA BREAST CANCER NETWORK NOVA SCOTIA CANADIAN LIVER FOUNDATION CANADIAN SKINPATIENT ALLIANCE CANCER ADVOCACY COALITION OF CANADA (CACC) THE CHRONIC MYELOGENOUS LEUKEMIA SOCIETY OF CANADA (CML SOCIETY) CARCINOID NEUROENDOCRINE TUMOUR (CNETS CANADA) COLON CANCER CANADA COLORECTAL CANCERASSOCIATION OF CANADA GASTROINTESTINAL SOCIETY HOPE AND COPE KIDNEY CANCER CANADA LEUKEMIA ANDLYMPHOMA SOCIETY OFCANADA LIFERAFTCANADA (GIST) LUNG CANCER CANADA LYMPHOMA CANADA MELANOMA NETWORK OF CANADA MYELOMA CANADA OVARIAN CANCERCANADA PANCREATIC CANCER CANADA PROSTATE CANCER CANADA RETHINK BREAST CANCER SAVE YOUR SKIN FOUNDATION TESTICULAR CANCER CANADA THYROID CANCER CANADA YOUNGADULT CANCER CANADA

9 White Paper The Institutionalized Discrimination of Cancer Patients A Business Case for the Universal Coverage of Oral Cancer Medications in Ontario and Atlantic Canada, The Cameron Institute, Jan 2014 The Canada Health Act provides for government reimbursement for IV cancer drugs because they are administered in a hospital setting There are major inconsistencies amongst provinces when it comes to cancer care especially oral chemotherapy Canadians living in British Columbia, Alberta, Saskatchewan or Manitoba have their cancer drugs paid by the provincial government regardless of their age, income level or whether they are IV and orally administered

10 The Analysis for Ontario 187,600 new cases of cancer In Canada in ,900 (38%) of them were in Ontario 21,858 of those new cancer cases in Ontario would be under 65 years 1,587 of those cases under 65 would be patients on social assistance leaving 20,271 not on social assistance

11 The Analysis for Ontario cont d Assuming, for Ontarians under age 65 the average private insurance coverage: 38% of these cases not on social assistance (7,703) would not be privately insured and 15% of those insured would have limited private insurance coverage (1,885), for a total of 9,588 financially vulnerable cancer patients in Ontario A sensitivity analysis was conducted for Ontario on the pool of 9,588 financially vulnerable new cancer patients assuming different levels of oral drug penetration and different drug costs

12 The Analysis for Ontario cont d Population penetration rates of 10%, 25% and 50% were used Four drug costs were used: Faslodex, an oral drug for breast cancer, was used for the lowend cost Gleevec was used for the high end cost In between costs were the average cost in Manitoba (which included reimbursement for all oral cancer drugs AND support drugs), and The average cost of a sample of oral cancer drugs A Business Case for the Universal Coverage of Oral Cancer Medicines

13 Last dollar Coverage The last dollar scenario, where the Province steps in after private insurance has paid its share, for a year s worth of oral cancer drugs for only new cancer cases would produce a budget impact of $28 million PENETRATION n-9588 ANNUAL COST PER CASE percentage number $2,000 (Faslodex) $5,770 (Manitoba) $45,000 (average Rx P) $75,000 (Gleevec) 10% 959 $1,918,000 $5,533,430 $43,155,000 $71,925,000 25% 2397 $4,794,000 $13,830,690 $107,865,000 $179,775,000 50% 4794 $9,588,000 $27,661,380 $215,730,000 $359,550,000

14 First dollar Coverage If the private insurance industry abdicates covering oral cancer drugs altogether the number of new cancer patients involved would more than double. For first dollar coverage the budget impact would be $58.5 million PENETRATION ANNUAL COST PER CASE n=20,271 percentage number $2,000 (Faslodex) $5,770 (Manitoba) $45,000 (average Rx P) $75,000 (Gleevec) 10% 2,027 $4,540,000 $11,695,790 $91,215,000 $152,250,000 25% 5,068 $10,136,000 $29,173,120 $228,060,000 $380,100,000 50% 10,136 $20,272,000 $58,484,720 $456,120,000 $760,200,000

15 Annualized Costs On an on going, annualized, first dollar basis, covering all cancer cases, and based upon the Manitoba experience of last year, full coverage would yield a budgetary impact for Ontario of $93,814,510 SCENARIO BUDGET IMPACT Last dollar coverage; new cases only; 50% Manitoba s cost $27,661,380 First dollar coverage; new cases only; 50% penetration; private insurance leaves market $58,484,720 All cases; annualized costs $93,814,510 Average of the above 3 scenarios $59,986,870

16 White Paper Conclusions There should be one funding mechanism for all cancer patients for all cancer drugs. Universal funding of oral cancer drugs is the right thing to do. Cancer patients, their families and compassionate caregivers should not be systematically discriminated against simply because of their place of residence, their age, their gender or their income level

17 Potential Implications What does a greater government role mean for employers and private drug plans? Need to remember the rationale for offering benefits : to attract and retain employees, to keep them healthy and at work, and to offer a safety net if they get sick. We would hope that employers continue to provide access to newly available oral therapies from NOC until such time as provincial governments reimburse them Employers can continue to provide access to oral therapies that do not get reimbursed on provincial formularies

18 Role for Employers? Employers need to take a leadership role in establishing a dialogue with provincial governments: * Aligning messages with cancer community Discussing the broad extent of the challenges Creating a sustainable system that works for all. The time is now! *STEPHANIE MAZZEI & BERNIE MANENTE, BENEFITS CANADA CONFERENCE, 2012

19 Next Steps: CanCertainty Campaign will launch March 10 Share the information Help us get the word out Support the campaign! Thank you Deb Maskens

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