Wednesday, February 16, 2011

Scrap The " Line " Stipulation

For many cancer patients who need life-saving treatments, the fact is that access to them can be "NIL".   The main reason is due to the high costs of these drugs.  Spending $7000, $12000, and even more a month is unimaginable if you don't have health insurance, and even if you do, then there are other obstacles you will encounter before you can get approval.   Even though your state or province may indicate that coverage of a particular cancer drug is available - it's still not that black or white whether you will be on the receiving end.
Why?  You have to read the fine print! Many of these government drug approvals have "special authorizations" attached.  This means that a particular treatment will only be covered based upon whether it is the patient's first-line or second-line treatment.  For instance - one of the leading drugs for kidney cancer is Sutent or Sorafenib - if you are a patient recently diagnosed with RCC your doctor may decide on giving you this particular drug as your "First-Line or First-Time Treatment".  Therefore, if this is one of the drugs that has been approved under governmental funding with a stipulation of first-line, then you would be approved for coverage.  If on the other hand, you have previously been on two or three other types of treatments such as Interferon, or Nexavar "before" being prescribed the Sutent, then government's approval will be denied since you would not meet the "first-line" stipulation.  That is government's way of putting road blocks to funding of these cancer drugs.  Sure, it all sounds well and good when you hear finance ministers announce in their annual budgets that they have approved coverage for certain drugs, but once you read through the fine print the picture is not as rosy as it initially appears.

The irony about all of this, is that cancer patients who need these life-saving treatments are unable to access them, and to me that is just plain cruel and unacceptable. It is the same as someone standing onshore with a life perserver, watching you struggle to reach shore and not doing a damn thing about it.

Cancer patients who have struggled to live and have battled all the obstacles that come their way, should NEVER be denied access to any treatment just because they don't meet the criteria such as first-line or second-line.  Do those in authority who make these rules and regulations understand that the reason these patients are here is due to the fact that they have been on other cancer drugs and have beaten such great odds stacked against them?  Why then, just when there is longevity offered in a newer treatment, will they be denied?  It makes absolutely no sense at all, other than the cost saving aspect for governments.

What about the scenario when "Sutent" has been approved as a first-line treatment:  if a patient had initially been on Sutent, then Interferon, then a third cancer drug, followed by a 4th type of cancer treatment and then returns to Sutent????  Do you think that would be considered  first-line? 
 Ah.....wonder what our government officials would say???


Anonymous said...

Interesting topic.

Ella said...

I wasn't aware that was the way it worked when a doctor prescribes a certain cancer drug. It is sad when cancer patients need these drugs and cannot get them.