Living your best life with arthritis.

Life-changing biologics: So close, yet so far

A person with a graduate hat and gownOliver Sachgau, a young university graduate living with juvenile arthritis, shared his medication treatment journey with the Globe and Mail this week. He was diagnosed with juvenile arthritis at the young age of 14. Throughout his high school and university years, he kept his arthritis symptom-free by taking the biologics Enbrel, which costs $1,800 a month and was thankfully covered under his family’s insurance plan.  When he graduated from university, he was no longer covered under his family’s health plan.

In the article, he said: “I’m not a unique case. Enbrel is part of a class of medication called biologics. For those who take them, biologics can perform miracles. But their high cost, which is rarely mitigated by medical coverage, has created a unique situation for thousands of Canadians who want, but can’t have, their life-changing medication.” The medication cost Canada’s public health plans more than half a billion dollars in 2013, for about 30,000 beneficiaries.

Biologics are produced by living organisms. Enbrel is part of a class of biologics called tumor necrosis factor alpha inhibitors, a human-made antibody. According to Dr. Edward Keystone, a professor of medicine at the U of T and senior consultant of rheumatology at Mt. Sinai Hospital, biologics have expanded treatment options for doctors and revolutionized the treatment of these diseases.

When asked about the cost of these medications, Dan Martinusen, a clinical pharmacy specialist at the Vancouver Island Health Authority, said: “The drugs are this expensive because they’re extraordinarily hard to create. For example, a non-biologic generic drug, a chemical clone of Advil, costs $1-million to develop. A biologic can cost more than $1-billion.

The Canadian Institute for Health Information reports the following:

  • In 2013, public drug spending declined, but spending on biologics increased.
  • TNF-alpha inhibitors (like Enbrel) accounted for the highest proportion of spending on all drug classes.
  • In Ontario, public health plans spent $201-million on TNF-alpha drugs in 2013, for ~10,700 beneficiaries. The second most expensive drug class, HMG-CoA reductase inhibitors, cost $179-million, with more than 1 million beneficiaries.
  • In British Columbia, public health plans spent $130-million in 2013, for ~7,800 beneficiaries. The second most expensive drug class, a medication used to treat schizophrenia, cost $41-million, with 87,000 beneficiaries.
  • Twenty-two percent of drug spending was being done out of pocket.

Person looking at tunnel aloneTo get covered for Enbrel, Oliver had limited options. His first option was to register for the Ontario Trillium Drug Program, which covers the cost of drugs relative to household income. The drug in question must be listed in the Ontario Drug benefit formulary; Enbrel is only approved for severe psoriasis. As a result, Oliver had to apply for exceptional access through his doctor. However, he got turned down because he hadn’t exhausted all his treatment options, which includes taking methotrexate in conjunction with another drug. Herein, Oliver was put in a time limbo.

This time limbo would consist of experimenting with two medications that may or may not work (which can take up to a year), trying to work out a solution with Enliven Services, a patient support program by Amgen, the company that makes Enbrel, and contemplating the switch to subsequent entry biologics. Luckily, Oliver qualified for long-term bridging at Enliven, which states that because Oliver had high prospects for full-time employment with benefits, Amgen will give him Enbrel for free for six months. After six months, they will re-evaluate his employment situation.

Are you in a similar situation as Oliver? Speak out to your government. Write a letter to your local candidate and your future Prime Minister and fight for something that matters to you this federal election, October 19.