Karen McLaren, 42, and Ashley McDonald, 38, have a lot in common.
The two friends attended Terry Fox Secondary School in Port Coquitlam, B.C., and worked together at Milestones restaurant in their early 20s.
When they were diagnosed with breast cancer as young women, they underwent mastectomies and gruelling rounds of chemotherapy.
They both thought that cancer was gone — only to have it reappear years later in different parts of their bodies.
That's where their stories diverge.
McDonald, who is a dual citizen of the U.S. and Canada and receives medical coverage through her employer, a major American airline, was put on a drug called Ibrance, which put her into remission.
McLaren, who has extended Canadian medical coverage, has run out of treatment options. Her body is no longer responding to chemotherapy.
She doesn't have coverage for the drug that saved McDonald. Ibrance isn't on the list of drugs covered by BC PharmaCare, the program that helps B.C. residents with the cost of eligible prescription drugs, nor is it covered elsewhere in the provincial Medical Services Plan.
The friends say their cases highlight the disparity in treatment options for women with metastatic breast cancer in the U.S. and Canada. They say their cases also challenge a commonly held belief that B.C. is the gold standard for cancer treatment in the country.
'My backup to save my life is another country'
McDonald, who now lives in Maple Ridge, B.C., was diagnosed with Stage One breast cancer in 2012, and opted for a double mastectomy and three months of chemotherapy. Her oncologist told her she was a "slam dunk case" for recovery, and that it was unlikely the cancer would ever come back.
Although she lives in B.C., her job is in the U.S., and she travels there to work.
But in August 2016, she underwent a test for a tumour marker — a substance produced by cancer cells that can indicate the disease has returned.
To her shock, she learned that her cancer had metastasized, was now considered Stage Four, and had aggressively invaded her organs.
She underwent 24 more rounds of chemotherapy — and was put on the drug called Ibrance. The pill, which she takes every day, blocks the enzyme that causes cancer cells to grow.
After three months, McDonald's remaining tumours had shrunk in half. Four months later, she was deemed to be in remission.
She later learned that, not only is Ibrance not covered in B.C., but the test that detected the return of her cancer isn't done anywhere in Canada.
"I always thought, it's crazy that my backup to save my life is another country," said McDonald.
"Then I found out that this other country — which I thought had a healthcare system that was so superior to the U.S. — doesn't test for the tumour marker that saved my life, and doesn't cover this drug that is responsible for pushing my cancer into remission after traditional chemotherapy failed to do that."
'No way I can't try this drug'
After battling breast cancer for 13 years, McLaren, who lives in Langley, B.C., has reached the end of her treatment options. She has private medical insurance through ManuLife, provided by her husband's work.
The former model was originally diagnosed in December 2004, and underwent a mastectomy on her right side along with multiple rounds of chemotherapy.
In November 2014, she discovered that her cancer had also metastasized, and was now present in the lining of her right lung.
By December 2017, the cancer had spread to her liver.
"I had the conversation with the oncologist. He said 'We've run out of options. Now's the time to have the end-of-life conversation with your family.'"
At that same December appointment, he told her about Ibrance, the drug that had saved McDonald. Because it isn't covered in B.C., it would cost her $8,000 every three weeks, out of pocket.
"There's no way I can't try this drug. It's the last thing that might save my life," McLaren said.
"It's crazy that I live in Canada, but now I'm looking at having to sell my house for coverage of my medication."
Earlier this week, McLaren walked to her local Shopper's Drug Mart and paid nearly $8,000 for a 21-day supply. On Tuesday she swallowed her first pill, worth $262.40 for just one day of treatment.
Ibrance under 'active review' in B.C.
Ibrance was approved by Health Canada in 2016, but provinces make individual decisions about what drugs they choose to cover.
In B.C., the province gives responsibility to the BC Cancer Agency to make coverage decisions about cancer drugs. Those decisions are based on the cost-effectiveness of the drugs, and the clinical effects for patients.
Helen Anderson, provincial lead for systemic therapy for the BC Cancer Agency, said that Ibrance is currently under active review for coverage in B.C.
"We want to make a decision as soon as possible," Anderson said. "I appreciate it's very frustrating."
Coverage for Ibrance is also under review in several other Canadian provinces.
That is cold comfort for McLaren. She said she feels "totally alone."
"I've got no one, except people like Ashley. Yeah, I'm jealous. But I'm happy for her as well."
McDonald said it's been difficult to share her good news, knowing her friend is surviving by doling out thousands of dollars every three weeks — which she can only sustain for so long.
"Getting put into remission with a Stage Four diagnosis is huge," she said.
"But knowing this, I can't celebrate."
This story has been updated to clarify that public Canadian health plans do not currently cover Ibrance.Jan 24, 2018 6:32 PM PT