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BC Ministry of Health sent a puzzling reply to HepCBC’s request for reimbursement of hepatic encephalopathy drug rifaximin (Zaxine™). BC is the only province/territory which does not cover it; many of BC’s End Stage Liver Disease (ESLD) patients are suffering from preventable brain damage because of this.
This drug has been shown to be of great benefit to patients suffering from ESLD, either in combination with lactulose, or instead of lactulose in cases where lactulose does not work. It is of particular interest to HepCBC because ESLD hepatitis C patients can take it while awaiting either treatment or transplant, without suffering unnecessary (and permanent) brain damage. CADTH has recommended that this drug is cost-effective, and that Canada’s pharmacares should reimburse it.
Nevertheless, BC is still refusing to cover it. They are reluctant to cover Zaxine™ because of “significant budget pressure, partially resulting from the extremely high cost of adding several highly effective products in 2015 for the treatment of Hepatitis C, as well as large number of other drugs under review. In addition, there are also ongoing requests for PharmaCare to further expand the current Hepatitis C coverage criteria.” Note that it has been shown that listing this drug would actually save the province money. See text of Ministry’s letter below:
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From: HLTH Med Ben & Pharm Services Correspondence Unit HLTH:EX <HlthMBPSDCorr@gov.bc.ca>
Date: Fri, Nov 4, 2016 at 11:34 AM
Subject: Ministry of Health response 1070584
Ms. Cheryl Reitz
Secretary, HepCBC Hepatitis C Education and Prevention Society
cherylreitz.hepcbc@gmail.com
Dear Ms. Reitz:
Thank you for your email of October 5, 2016, regarding rifaximin (Zaxine™) for the reduction in risk of the recurrence of Hepatic Encephalopathy (HE). Your email was forwarded for my response by Mr. Martyn Lafrance, former Chief of Staff to Honourable Terry Lake, Minister of Health. I apologize for the delayed response.
I appreciate receiving your recommendation that, in light of the Canadian Drug Expert Committee Recommendation, rifaximin be listed on the formularies of jurisdictions participating in the Common Drug Review process for reducing the risk of HE recurrence, if patients meet specified clinical criteria.
The Ministry of Health (the Ministry) is still reviewing rifaximin for PharmaCare coverage and has not made a final listing decision. At this time, it is not known when the Ministry will be able to complete this review.
The PharmaCare program is currently facing significant budget pressure, partially resulting from the extremely high cost of adding several highly effective products in 2015 for the treatment of Hepatitis C, as well as large number of other drugs under review. In addition, there are also ongoing requests for PharmaCare to further expand the current Hepatitis C coverage criteria.
I appreciate that while this is not the response you were hoping for, I hope that you understand and will continue to work together with the Ministry to balance PharmaCare’s sustainability efforts while judiciously adopting new drug therapies.
Thank you for the opportunity to respond, and trust this information is helpful.
Sincerely,
Barbara Walman
Assistant Deputy Minister
Medical Beneficiary and Pharmaceutical Services Division
pc: Honourable Terry Lake