N.S. senior blasts province over blood thinner coverage under pharmacare
Province covers Warfarin, but it requires closer monitoring than newer, more expensive alternative, Apixaban
A Nova Scotia senior is questioning how the province's pharmacare program for seniors decides which drugs to cover after his blood thinner was rejected, while the one that was approved requires close monitoring and blood tests.
Ken MacDonald of Port Morien said he's now paying $120 a month for the drug his doctor recommended. He points out many other seniors couldn't afford to do the same.
"For me, it's not the money as much as it upsets me that low-income Nova Scotians can't afford Apixaban, and it requires a lot more effort on their part to get treatment for the condition that they have [by using Warfarin]," he said.
MacDonald was diagnosed with atrial fibrillation — an irregular heartbeat — a year and a half ago. His doctor prescribed Apixaban to help prevent the risk of a stroke.
When he turned 65 last year, he switched to the pharmacare program for seniors, which rejected the drug and recommended Warfarin instead.
Warfarin requires regular testing
People taking Warfarin need to have their blood checked every two to three months, depending on the patient, a pharmacist confirmed to CBC News.
MacDonald said while the medication is cheaper, there are some drawbacks.
"How much does it cost the health-care system to pay to get the lab results produced?" asked MacDonald. "How much does it cost for follow-up appointments to the doctor that they have to pay for too?"
MacDonald said he contacted the pharmacare program and the health minister about the issue.
He said his physician also wrote an appeal to have the drug covered, but it was turned down.
Heather Fairbairn with the Nova Scotia Health Department issued a statement in response to MacDonald's concerns.
She said the program uses the Canadian Drug Expert Committee for guidance on what to cover. The committee is made up of physicians, pharmacists, public members and others with expertise in drug management.
She said the price of blood testing was factored into their decision not to cover Apixaban, which is a newer blood thinner.
"The Nova Scotia criteria are consistent with other publicly-funded drug programs in Canada," wrote Fairbairn.
Changing the role of pharmacies
There is a pilot program underway for pharmacare patients to specifically address this issue through the Pharmacy Association of Nova Scotia. Pharmacists at 41 pharmacies are testing in-house the blood of patients on Warfarin.
"In the project, the pharmacists are actually able to do the test with a finger-prick blood test," said Lisa Woodill, director of pharmacy practice for the association.
Patients learn the results in about 10 minutes.
"The pharmacist would let the patient know if they need to make any changes to the dose of their medication, and prescribe that new dose for them."
She adds they also work closely with family physicians if there are concerns about a patient's results.
Woodill said they'll know the full results of the pilot in a few months, but so far it appears to be cutting down on costs both for the health-care system and for patients.
"Certainly from the patient prospective, we've also looked at time from a patient cost. Time to travel to the lab, time off work for themselves, or sometimes it's a caregiver that has to take time off work to get to the lab," she said.
She said in some cases, patients are seeing better outcomes because they're being monitored on a regular basis.
About 850 Nova Scotians are enrolled in the program. New patients will only be accepted at those locations if they do not have a family doctor.
A list of the participating pharmacies can be found here on the assocation's website.
'Symptom of a wider problem'
MacDonald, meanwhile, said he plans on continuing to pay for Apixaban out of pocket.
But he wants to continue to advocate for those who don't have that option.
"This is a symptom of a wider problem in our health-care system," he said.
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