Universal cancer coverage problem will only 'get worse'

A cancer care specialist at Capital Health is speaking out about the enormous cost some cancer patients are required to pay out of pocket for their potentially life-saving medication.

Province pays for IV cancer treatments, but not for treatments when done in pill form

In many provinces, cancer drugs are covered by the provincial government, whether the patient takes the medication in hospital or at home in pill form — but not in Nova Scotia, the other Atlantic provinces and Ontario. (CBC)

A cancer care specialist at Capital Health is speaking out about the enormous cost some cancer patients are required to pay, out of pocket, for their potentially life-saving medication.

Mary Lou Robertson, a medication resource specialist with the Capital Health Cancer Care program in Halifax, is also a part of CanCertainty  a coalition of 35 cancer organizations calling for fairness in drug costs.

"I work full-time helping those who don't have enough insurance coverage or who have difficulties with their insurance coverage paying for oral cancer medications or paying for injectable cancer medications, what we call take-home meds," she says.

Robertson says she sees people who can't afford the drugs everyday.

"I see about 50 to 60 new cases per month and those are the cases where there's complexity or difficulty in trying to access things through their insurer — either their insurance is going to end, they don't have enough insurance, or someone without insurance at all who needs to be linked with our Nova Scotia Pharmacare program," says Robertson.

'It's only going to get worse'

In many provinces, cancer drugs are covered by the provincial government, whether the patient takes the medication in hospital or at home in pill form — but not in Nova Scotia, the other Atlantic provinces and Ontario.

Robertson says she wants all provinces to fund cancer drugs for all patients, not just those drugs administered intravenously in hospital.

"I shouldn't have this job. I shouldn't be walking into a room and saying just because your approved treatment comes in pill form, you're going to have to pay it. But I'm going to help you figure some ways to put some things together to help you out," she says.

She says the idea of people coming in to hospital, being hooked up to an IV for chemo drugs is changing as new drugs hit the market.

"Increasingly, we're now seeing medication come out in pill form or injectable form that people are able to receive at home," she says.

"It's only going to get worse."

It can usually takes two to three weeks to secure money through a "mishmash" of funding from insurance companies, provincial Pharmacare, and pharmaceutical-sponsored programs. She says sometimes it takes up to six weeks, depending on the case. In the meantime, those in need, wait.

"It's a lot of stress on the patient, it's a lot of back and forth, a lot of paperwork and patients tell me they have sleepless nights," says Robertson.

"You've already been told you have cancer. You have questions going through your head like 'How am I going to tell my kids? How am I going to tell my employer? What am I going to do for money?' And then I walk in and I say, 'Well, your cancer therapy costs $6,000 a month, do you have insurance?' You can imagine then there's 10,000 other questions on top of that about what's ahead."

System "not consistent" and "insufficient"

Despite the hurdles, Roberston says she's able to help about 98 per cent of people who come to her for help.

"And usually the ones I can't, it's something that's not your typical situation. It might be a rare cancer or something where we're trying a new drug that may not have full approval yet," she says.

"But the majority of cases I work on are drugs that have been approved. The province has endorsed them, they say these should be used for cancer treatments."

Roberston says the system is "not consistent" and "insufficient."

"So if you don't have sufficient insurance, you turn to the Pharmacare program, but it's based on income. So if you think of your median income in Nova Scotia being around $67,000 gross per year — that's before taxes and your deductions — that person would have to pay, on average out of their own pocket, another $13,000 towards their therapy. The province will kick-in the rest but who amongst us making that salary has $13,000 kicking around?"