Fighting for drug coverage

Aethne Hinchliffe
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Sometimes Edna Mae Whynot’s pain from arthritis is so bad she sits hunched over and crying.

 

Edna Mae Whynot wishes the drug that has been helping her arthritis so much would be covered. Her doctor has written letters to the Department of Community Services with no response.

The 58-year-old woman is on social assistance and can’t get coverage for a medication she calls her “miracle drug.”

One of Whynot’s doctors has written multiple times to the Department of Community Services requesting it consider paying for the medication but has received no response.

Whynot says she’s had minor arthritis since her 30s but nothing major until about four years ago. In the summer of 2009, Whynot decided it was time to see her doctor.

After a bone-scan, says Whynot, she learned she had three kinds of arthritis.   

“So I had it in my neck, my whole back, shoulders and my hands and my knees and my feet,” she says.

Initially Whynot took a narcotic, but that didn’t work, she says.

“During that first year, I was on every narcotic I think possible,” she says.

Whynot says it was difficult for her doctor to find something for her that wouldn’t have too many side effects but would also help the pain. Things stayed the same for a while with Whynot continuing to try various narcotics.

About a year ago, Whynot’s doctor gave her Tridural, but according to one of the letters, the drug-manufacturer’s representative is providing it, which means Whynot cannot get the medication indefinitely.  

“After I got through the withdrawal effects (from the narcotics), I couldn’t believe that this pill took all the pain away,” she says.

The medication costs $59.60 for 14 days.

Whynot says within three days of taking Tridural, her pain goes away. Not having pain allows Whynot to do things she says she enjoys, such as getting out and walking and enjoying nature.

According to Whynot, her doctor has enough cards for the drug to last until December.

“After that, if he doesn’t have any cards, then I’ll have to go back on the narcotic again,” she says.

Whynot contacted Nova Scotia’s Medical Service Insurance. She says when she asked why the medication wasn’t covered, the response was it’s not covered for various reasons.

According to Patricia Jreige, communications advisor with the Department of Health and Wellness, the decision of which drugs are added to the formulary comes from recommendations made by national expert-advisory committees. Once recommendations are received the department conducts an internal review.

The review, says Jreige, includes studying the budget impacts and effectiveness of the drug.

“In the case of Tridural, it was reviewed through a national-review process known as the Common Drug Review Process,” says Jreige.

“All publically funded drug programs in Canada, with the exception of those in Quebec, participate in this same process and receive recommendations from an independent committee of drug-therapy experts.”

Jreige says the committee didn’t recommend Tridural be insured by the public drug program.

“There was no evidence in terms of clinical studies to support that Tridural provided a therapeutic advantage over other therapies that are currently insured by pharmacare programs,” adds Jreige.

Jreige says pharmacare is generally open to all Nova Scotians, whether or not they have private insurance.

Though Tridual is not covered, Jreige says there would be other options on the formulary.   

Organizations: Community Services, Department of Health and Wellness

Geographic location: Nova Scotia, Canada, Quebec

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