Patient Patients

Published November 1, 2003

Canadian drug prices are the envy of politicians like Illinois Gov. Rod Blagojevich, who hopes to save a little money on his state’s Medicaid and employee health programs by importing cheaper drugs from Canada. The governor has set this course even though it violates Food and Drug Administration regulations and even though the FDA can’t guarantee the safety or effectiveness of imported medications.

Before going on that bargain buying spree, the governor might ask Canadian Linda Wilhelm of New Brunswick how Canada keeps its prescription drug prices low. Her answer certainly might give his constituents pause.

Mrs. Wilhelm, a 43-year-old mother of three, is among 4 million Canadians who suffer from some form of arthritis, the nation’s largest cause of long-term disability. Her rheumatoid version, first diagnosed in 1983, has proven particularly aggressive. It has necessitated six joint replacements. Cost: $540,000 over 10 years.

So you would think that to prevent further joint replacements and the possibility the disease might lead to more expensive treatments for glaucoma, Canada would have rushed to allow her access to a new wonder drug, Enbrel, when it came out in 1998.

A biologic, the drug virtually halts inflammation. At $1,500 a month it was a bargain compared with the $800 a day the government paid for hospital, home, surgical, drug, and other therapy. Further, it would immensely improve Mrs. Wilhelm’s quality of life, allowing her to become fully mobile for the first time in years.

But Canadian officials, like Blagojevich, like their drugs cheap and their prices controlled. The Patented Medicines Prices Review Board (PMPRB)–Canada’s FDA–won’t accept clinical trials from other countries, even advanced ones such as the United States. And even after that hoop is jumped through, new drugs have to run through a gamut of provincial formulary rules, which can keep the drugs unavailable in many parts of the nation. And that’s exactly what has happened with Enbrel.

“When I first found out about the drug, I knew it was what I needed,” Mrs. Wilhelm said. “My husband was afraid to go to work; my daughter was afraid to go to school, because of my condition. They didn’t know if I would need carrying to the bathroom.”

But the government wouldn’t let her have it. Even after the Canadian federal government finally passed upon the safety and effectiveness of the drug in December 2000–more than two years after its introduction in the United States–the drug continued to require approval from a patient’s provincial government before patients could get it for treatment.

“I kept phoning and writing the provincial government and kept bugging them every day. I contacted my federal MP (elected representative). The federal guys kept tossing it back to the provincial guys, who said they can’t pay for it because it’s not approved. Finally, I got the MP to hammer out a deal so I could take the drug on a trial basis. That was in 2001. A lot of politics.”

The difference the drug has made is like night and day. “The whole life of the family used to revolve around my disease,” she said. “Now I can actually go on vacation. My daughter can go to school and my husband to work without being afraid. I am no longer 75 to 80 percent disabled.”

Still Rationed

But many Canadians who need the drug still can’t get it even today–five years after its introduction in the United States. The U.S. pharmaceutical industry created Enbrel, as well as most other new miracle drugs. Canada produces no new drugs.

Canada keeps the prices for drugs cheap by letting others develop them, and then making its people suffer for years without access to them.

Is that the kind of devil’s bargain U.S. health care consumers want?

Duane Freese is a columnist for Tech Central Station and has 26 years experience writing opinion, features, and news. His email address is [email protected]. A version of this article was first published by Tech Central Station on October 2, 2003 and is reprinted with permission.