The Honourable Terry Lake Victoria BC, V8W 9P1...
Transcript of The Honourable Terry Lake Victoria BC, V8W 9P1...
FH Canada Patient Network 151 Bloor St West, Suite 600, Toronto ON M5S 1S4
Tel: (416) 969-7464 http://www.fhpatientcanada.org
TheHonourableTerryLakeMinistryofHealthPOBOX9639STNPROVGOVTVictoriaBC,V8W9P1DearMinister,IamwritingtoyouonbehalfoftheFHCanadaPatientNetwork(FHCPN)tourgeyourimmediateattentiontocorrectingapuzzlinganomalythatisaffectingthewell-beingandlivesofpatientswithprimaryandfamilialhighcholesterol.ThisissuecametoourattentionwhentheFHCPN,astheonlypatientdrivenorganizationforfamilialhypercholesterolemiainCanada,waspreparingoursubmissiontotheCommonDrugReviewcommentingontwonewtherapies(PCSK9).OursurveytoFHpatientcommunityconfirmedwhatiswellknown:forthemajorityofpatientwithhighcholesterol,familialandnonf-familial,statinsworkverywellinmanagingLDLcholesterol(LDL-C,theharmfulor“bad”cholesterol)tolevelsthatprotectagainstheartdiseaseandstrokes.Forthosewhoweremoreresistant,theadditionoforchangetoezetimibewaseffectiveinachievingtargetLDL-Clevels.TheanomalyinourfindingswasthatrespondentsfromQuebecandBritishColumbiaweremorelikelytoreportthattheirLDL-Cwasnoteffectivelymanageddespitetheircurrentdrugtherapies.QuebecweunderstoodbecauseofthehighprevalenceofFamilialHypercholesterolemiainthosewithFrenchheritage.BritishColumbiawedidnotunderstanduntilphysiciansenlightenedustothefactthatezetimibe(Ezetrol)wasnotontheBCformulary.Incontrasttootherprovinces,Ezebrolcanonlybeaccessedthroughthepublicdrugplanthroughaspecialauthorizationprocess.Notonlyistheprocesscumbersomebutthedrugisoftendenied,whichreducesmotivationtoprescribebutmore,importantly,reducesaccessbypatientswhoareinneed.InApril2016,atourFHpatientforuminVancouver,physiciansalsospoketoglobalevidencewhichshowedthatby”loweringLDL-Cfurther,ezetimibesignificantlyreducesmajorcardiovasculareventsincludingheartattack,strokeandcardiovasculardeathwhenaddedtoastatininindividualsathighriskforcardiovasculardisease.” According to treatment guidelines, ezetimibeisindicatedforpatientswithveryhighcholesterol(oftenduetogeneticandnotlifestylefactors)forwhomthehighestdosagesofstatintherapyareinsufficient,aswellasthose(upto20%)ofpeoplewhogetintolerablesideeffectsfromstatins,sotheycantakenostatinsornotahighenoughdosagetolowercholesteroltosafelevels.
FH Canada Patient Network 151 Bloor St West, Suite 600, Toronto ON M5S 1S4
Tel: (416) 969-7464 http://www.fhpatientcanada.org
Paradoxically,becauseEzetrolisnotlistedontheBCformulary,thereisnorequirementthatthegenericformofezetimibebeprovidedat25%orthebrandprice,whichwouldactuallyresultinasignificantcostsavings.BynotlistingEzetrol,BCisforcingphysicianstoexpendtimeandeffortonunnecessarybureaucraticprocess,keepingthepriceofezetimibetherapyhigherthannecessary,and,mostimportanty,reducingaccesstolife-enhancingandlife-savingtherapyformanyBCpatients.WeurgeyoutocorrectthisdeficiencyintheBCdrugplanassoonaspossible.Astheonlypatient-drivenorganizationdedicatedtohighcholesterolandhighlipids,wewouldbemostpleasedtoworkwithyouonthisandotherissuestoimprovethecost-effectivenessofthehealthcaresystemandthelivesofall. Sincerely,
DurhaneWong-Rieger,PhDChair,FHCanadaPatientNetwork151BloorStreetWest,Suite600Toronto,OntarioM5S1S4(416)969-7435or(647)[email protected]:BarbaraWalman,ADMPharmaceuticalServicesDivisionEricLun,BCPharmaceuticalServicesDirector