[Newsbot]

Title: OHIP doesn't cover drug that could extend dying mom's life
Category: Health
Posted By: saturn_656
Date: 2013-10-30 20:29:07
Canadian

[BeaverFever]

I don't have an opinion as to whether OHIP should cover this drug, or that drug, and under what circumstances coverage should be provided. But I do understand that all insurers - be they public or private - make these decisions through policies and guidelines, cost-benefit and cost-effetiveness anaylyses, etc.

I also understand that no matter how generous those guidelines are, there will always be treatments and patients who don't qualify for coverage due to their specifics and are adversely affected as a result.

I also wonder why this article (The Sun, surprise suprise) takes OHIP to task for the situation, but not the employer's private plan, whose benefits are supposed to pick up where government coverage leaves off.

I also enjoy how the article, and the commenters beneath it, make it seem like this is somehow a strictly Liberal decision, as if they had anything to do with it. Also amusing is that this article seems to calling for MORE political interference in day-to-day bureaucratic decisions and MORE generous spending rules, a dramatic departure from their usual position.

There is newsworthiness to this patient's story, as it relates to the general and ongoing debate on what should or should not be covered under OHIP, and how the 'benefits' of high-cost treatments for already terminal patients should be calculated. But the purpose of this particular article is really just another SUN attempt to blame the Liberals for anything and everything.

[saturn_656]

Interesting, you make no reference to the woman who is the subject of the article. At all.

You know, the one who has than less two months left to live as things stand?

EDIT: It's pretty easy to pin things on the Ontario Liberals, they screw damn near everything up.

[BeaverFever]

$1:

Interesting, you make no reference to the woman who is the subject of the article. At all.

You know, the one who has than less two months left to live as things stand?

Should I have?

Shes dying, it's sad. But you miss my point entirely. Because there is not one set of OHIP policies for this woman, and a different set of policies for other people so IMO "referencing her" does nothing to further the discussion of whether drug x should be covered and under what circumstances.

Are the current OHIP rules right? As I said in my post, I don't know and it's worthwhile to constantly review and debate them on an ongoing basis. But regardless, at the end of the day, whatever rules are put in place, there will always be someone who doens't meet them. For example, lets say OHIP caves and decides to change the rules to cover this drug, but only if it prolongs life at the current quality for at least 6 months. We will still see a similar article to this one about the woman who was denied because the treatment is only expected to have her life prolonged by 5 months. And then I will need to "reference" that woman?

And while you may wish to blame the Liberals for the things they have done, this particula issue is not something handled at the political level and the policy in question predates the Liberal era.

[llama66]

its not the Liberal party thats turned her down, its OHIP (yes there is a liberal health minister, but I doubt he's active in the day to day operation of OHIP). Its the doctors (the ones who read medical journals and know about pharmaceuticals and such) that turned her down.

Bevacizumab (its actual name) is in clinical trials and hasn't produced concrete results that it actually DOES work at extending life. At one point the FDA approved it for use in breast cancer treatments but revoked it a short while later because it showed there was no evidence that it extended life or improved quality of life, and it caused adverse effects including severe high blood pressure and hemorrhaging.

Most insurance companies wont pay for it because it is so expensive. OHIP won't cover it because the minimal benefits it has on cancer. The actual estimated costs in Canada for the drug is actually closer to $40,000 per year and not $100,000.

There is also the side effects, it inhibits the growth of blood vessels which can lead to hypertension and bleeding or necrotizing fasciitis which can be fatal.

Here is a quick blurb from the Brain Tumor Foundation of Canada about Bevacizumab https://www.braintumour.ca/4710/bevacizumab-avastin-update--june-2013

I know alot about this because I lost my dad 3 years ago when the the Renal Cell Carcinoma he had metastasized into his lungs and then his brain.

[Regina]

"OHIP" doesn't doesn't cover drugs till you are 65+ and is always up to the user to pay for medications until then, either by cash or by private insurance plan. Her private provider wouldn't approve the drug coverage, so as with the rest of us in Ontario the individual must pay. The only time medication is covered by the province is when you are an in-patient of a hospital.
The article also fails to mention if the drug is approved by Ontario to be used. Health Canada must first approve a drug's safety etc. then for some strange reason each goes along and repeats the tests then approves it for use. Ontario is probably the slowest at getting these test done and drugs approved. They consider a year to be fast tracking so it's no wonder other provinces are already using it. Also Ontario being the largest buyer in Canada will try to negotiate a lower price which takes more time.

[BeaverFever]

Regina Regina:

"OHIP" doesn't doesn't cover drugs till you are 65+ and is always up to the user to pay for medications until then, either by cash or by private insurance plan. Her private provider wouldn't approve the drug coverage, so as with the rest of us in Ontario the individual must pay. The only time medication is covered by the province is when you are an in-patient of a hospital.
The article also fails to mention if the drug is approved by Ontario to be used. Health Canada must first approve a drug's safety etc. then for some strange reason each goes along and repeats the tests then approves it for use. Ontario is probably the slowest at getting these test done and drugs approved. They consider a year to be fast tracking so it's no wonder other provinces are already using it. Also Ontario being the largest buyer in Canada will try to negotiate a lower price which takes more time.

There are actually a few different drug programs in Ontario, the ODB for Age 65+ is the most well-known, but Trillium Drug Program is for people who "have high prescription drug costs relative to their household income." There is also The New Drug Funding Program (NDFP) for Cancer Care, and a Special Drugs Prgogram (SDP) for very specific treatment of certian health conditions. Plus a few other ones, again for treatment of very specific conditions:


http://www.health.gov.on.ca/en/public/programs/drugs/programs/programs.aspx

[saturn_656]

http://www.gofundme.com/4vidz4

Kimm Fletcher has a gofundme page to help raise funds for the medication she needs, if anyone is interested.

[Regina]

I'm aware of the other programs and they usually involve some institution stay and treatment, may it be a day patient, overnight or long term. I just didn't want to muddy the discussion with more detail............or point out the fact we haven't used the term OHIP in over a decade.

[BartSimpson]

Seems to me the criticism of Suzanne Sommers was a little premature, wasn't it?

[saturn_656]

BartSimpson BartSimpson:

Seems to me the criticism of Suzanne Sommers was a little premature, wasn't it?

Even a broken clock is right twice a day.

[BartSimpson]

saturn_656 saturn_656:

BartSimpson BartSimpson:

Seems to me the criticism of Suzanne Sommers was a little premature, wasn't it?

Even a broken clock is right twice a day.

I agree. I'm hardly a fan of hers but her comments about her 75 year old friend are clearly validated in this story.

[Regina]

BartSimpson BartSimpson:

Seems to me the criticism of Suzanne Sommers was a little premature, wasn't it?

Not at all. What part of those two stories seem similar? One involved unapproved medications and the other an unspecified cancer treatment.

[BeaverFever]

BartSimpson BartSimpson:

saturn_656 saturn_656:

BartSimpson BartSimpson:

Seems to me the criticism of Suzanne Sommers was a little premature, wasn't it?

Even a broken clock is right twice a day.

I agree. I'm hardly a fan of hers but her comments about her 75 year old friend are clearly validated in this story.

What's the hell are you trying to say Bart? That if this person had been in the US, the US public program would have paid for her drug therapy???? Because I don't think that's the case.

[BeaverFever]

$1:

or point out the fact we haven't used the term OHIP in over a decade.

Who hasn't used the term OHIP???

$1:

Ministry Programs

Ontario Health Insurance Plan (OHIP)







Important update: The government is making changes, based on medical evidence, to OHIP coverage of vitamin D testing. Click here for more information.


A resident of Ontario must have a health card to show that he or she is entitled to health care services paid for by OHIP. The Ministry of Health and Long-Term Care pays for a wide range of services, however, it does not pay for services that are not medically necessary, such as cosmetic surgery.

To apply for OHIP coverage, you must go in person to a ServiceOntario centre.

http://www.health.gov.on.ca/en/public/programs/ohip/