In Quebec, in this case.
Evidence of meeting #51 for Health in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was cdr.
A recording is available from Parliament.
Evidence of meeting #51 for Health in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was cdr.
A recording is available from Parliament.
5:20 p.m.
Conservative
5:20 p.m.
Oncologist, University Health Network, Princess Margaret Hospital
In Quebec. I can only speak to what I've heard. A good colleague of mine, Dr. Jeremy Sturgeon, has moved to Montreal to try to help deal with this problem. What he has said is that this happens. A patient will come into a hospital, and Avastin, for instance, won't be funded, so they'll get an appointment with a doctor in the hospital across town, or something.
Although on paper I think Quebec sounds like they might be behaving a bit like British Columbia, which we're holding up so highly, I think there's still a lot of unfair disparities there.
5:20 p.m.
Director and Past Chair, Cancer Advocacy Coalition of Canada
But that's not an issue of the doctor; that's an issue of the hospital at which the doctor works. So he or she may realize, I can't give this drug to this patient referred to me, so don't send the patient to me.
5:20 p.m.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
What about outside? I assume that outside of Quebec a family physician can prescribe a drug and there's no discrepancy from family doctor to family doctor within that province.
Are you suggesting that there is a difference, even outside the hospitals, when prescribing drugs?
5:20 p.m.
Director and Past Chair, Cancer Advocacy Coalition of Canada
I think almost all the drugs are prescribed by oncologists, and I would think there's much greater uniformity by oncologists in the prescription of cancer drugs.
5:20 p.m.
Conservative
5:20 p.m.
President, Colorectal Cancer Association of Canada
I can give you a specific answer with respect to Quebec by way of the example of one medication, Avastin. We know that Avastin has federal approval, so the safety requirements have been met and it is available. Two provinces fund it: British Columbia and Newfoundland. In Quebec, although it forms part of the treatment guidelines for colorectal cancer, and those were set in Quebec, unfortunately, only one hospital is paying for this drug out of its hospital budget.
So having something within the treatment guidelines is not necessarily a guarantee that it will be offered to the public, and that's something, of course, that we're addressing in Quebec. Guidelines are very important, but they don't necessarily guarantee that it will be reimbursed.
5:20 p.m.
Conservative
April 30th, 2007 / 5:25 p.m.
Liberal
Bonnie Brown Liberal Oakville, ON
I have a couple of questions. One is for Mr. Stein, who self-disclosed that he had tried some out-of-country treatments that were not approved here yet. I'm wondering, first of all, if I may ask, whether you had to pay for those out of your own pocket.
5:25 p.m.
President, Colorectal Cancer Association of Canada
In my case, going back to 1996, it was really types of surgery and surgical delays. And there was what we call hepatic arterial infusion, a process for infusing chemo directly to the liver, that wasn't offered in Canada. So the delays were a big issue, perhaps, more so than the actual medications.
The principle is still the same, and that applies, for example, in Ontario, where patients are leaving Ontario to go to Buffalo, to Roswell Park, to receive Erbitux. Then they're reimbursed through OHIP, yet they can't get it in their own province. These anomalies seem to go on throughout the country, particularly....
Let's get down to the point. When we talk about cost-effectiveness, we're talking about cost. It is also about the effect, but really, if the cost were very little, we wouldn't be worrying so much about it. So what we need to do to have equalization of these types of treatments is to have perhaps a new and novel method of reimbursement.
This is an example--I always throw out examples to make people think. What if we had a system, an insurance plan, like we have in Quebec? What if the federal government created a special drug fund for expensive cancer treatments? And what if the pharmaceutical companies would lower their prices, knowing there would be greater access to the availability of the product? Perhaps we need new and novel solutions.
When I left the country, it was life and death. I could stay in Canada and accept my fate or go and get these--accepted, by the way--treatments. You can't just leave the country and expect to be reimbursed. We understand. We have a process for that. In my case, I spent $250,000, and ultimately, through the Quebec Superior Court, RAMQ was ordered to reimburse. The same principles apply, though, today.
5:25 p.m.
Liberal
Bonnie Brown Liberal Oakville, ON
Those treatments you got elsewhere and paid for and then were later reimbursed for, are they common procedure now in Montreal?
5:25 p.m.
President, Colorectal Cancer Association of Canada
As I said, some of it had to do with the timeliness, being available to have surgery at that time. This was at a time when--
5:25 p.m.
President, Colorectal Cancer Association of Canada
It was a wait time issue, for sure. And it was also an issue of treatments, which are still not available in Canada but are readily available in every major cancer centre in the United States.
Dr. Knox talked about fearing what would happen in Canada when drugs such as Sutent or Avastin are not readily available. We fear that because they are readily available elsewhere as part of the normal course of treatment within the treatment guidelines, patients will have to leave the country for the very same reasons.
5:25 p.m.
Liberal
Bonnie Brown Liberal Oakville, ON
Thank you.
We all know that in the past, Health Canada checked for safety, and the provinces and territories did their own reviews for efficacy and cost-effectiveness, and then they listed or did not list it on their formulary. They made that decision.
Now we have the CDR and the JODR in the middle of that process giving recommendations, which the provinces may or may not follow but tend to follow. Would any of you rather go back to the earlier system, when each province made the efficacy and cost-effectiveness decision? Would you rather go back to the system you had than the one you don't seem very happy with today?
5:25 p.m.
President, Canadian Breast Cancer Network
The problem with the system we have in terms of cancer drugs is this inequality across the country. We joke around that we don't know whether or not we're going to develop metastatic disease, but maybe we'd all better move to British Columbia in case we do. It's unacceptable.
5:25 p.m.
Liberal
Bonnie Brown Liberal Oakville, ON
Ms. Ermel, what you're talking about is actually based on our Constitution.
5:25 p.m.
Liberal
Bonnie Brown Liberal Oakville, ON
The provinces have the right to deliver health care, and they have the right to decide which drugs they will pay for.
On the part of your speech that you gave about equal access and equal reimbursement, how do you think it's going to happen?
5:25 p.m.
President, Canadian Breast Cancer Network
I don't know, but I believe it should happen. I have actually said we may have to go back and change the BNA Act, but I don't know. It is not right that this is happening across the country. It is just not right.
These gentlemen have thought of more ways around this. I think people who have really put their minds to looking at fair and just solutions need to be listened to.
It's almost like it's a cop-out. Well, it isn't almost like a cop-out; it is a cop-out that federally we can't do anything because it's the job of the provinces, and the provinces say they don't have enough money. Everybody has to work together to do something.
One of my board members e-mailed me and said the system is broken, tell them to figure out how to fix it. There are plenty of people with expertise and ideas on how this can be fixed.
5:30 p.m.
Liberal
Bonnie Brown Liberal Oakville, ON
Dr. Hryniuk, at one point, you or some people on the panel were talking about national guidelines. Have the oncologists come up with agreed upon national treatment guidelines?
5:30 p.m.
Director and Past Chair, Cancer Advocacy Coalition of Canada
Some have and some haven't. All of the United States operates under one set of guidelines, the NCCN guidelines. For all of us in this room, we would do well to put that down in our books. NCCN.org tells you how each cancer should be treated.
5:30 p.m.
Liberal
Bonnie Brown Liberal Oakville, ON
But have the Canadian oncologists as a society come up with guidelines?
