By Eric Lun
Executive Director, Drug Intelligence and Optimization Branch
Medical Beneficiary and Pharmaceutical Services Division
Ministry of Health

VICTORIA - In response to Robert Oliphant's column ("Drug switch puts cash before patients," Aug. 12) I'd like to give the facts about PharmaCare's decision to change which DPP-4 inhibitor drugs it covers for diabetics.

After a thorough therapeutic review, PharmaCare will cover two DPP-4 inhibitor drugs, linagliptin and saxagliptin. PharmaCare will not cover a third, more expensive drug, sitagliptin (Januvia.) These drugs are used for Type 2 diabetics, when insulin and other first-line treatments have not worked. Experts agree all three drugs are equally effective and safe.

PharmaCare is choosing to cover the two more economical options to ensure value for money for taxpayers. This decision will save PharmaCare millions of dollars a year, in order to fund other drugs and programs.

For patients on sitagliptin (Januvia), we will allow six months for them to transition to one of the two covered DPP-4 drugs. This will allow patients to use any drug supply they may have, and to have their prescription adjusted at their next regular doctor visit.

In making this decision, PharmaCare sought advice from the province's expert Drug Benefit Council, engaged drug manufacturers, and consulted with endocrinologists, patient advocacy groups, Doctors of B.C. and the B.C. Pharmacy Association. 

Mr. Oliphant asserts PharmaCare quietly changed coverage of these types of drugs. In fact, we have been diligently informing patients, doctors and pharmacists about the change through letters and our PharmaCare newsletter.

He also claims patients will no longer have access to public funding for sitagliptin (Januvia.) In fact, patients who are unable to tolerate linagliptin or saxagliptin may apply for exceptional coverage for sitagliptin (Januvia) through PharmaCare's Special Authority process.

Mr. Oliphant's most concerning claims are "(t)here is no evidence that you can simply swap one drug for another, a practice known as therapeutic substitution..." and "(d)rug plan managers throughout the developed world do not support therapeutic substitution..."

There is substantial evidence showing therapeutic substitution to be safe and effective. Scientific evaluations of B.C.'s policies on therapeutic substitution have been published by leading researchers in top-tier medical journals, including the New England Journal of Medicine and the Canadian Medical Association Journal. 

These studies found substitution was safe for patients and saved money. For example, Harvard researchers found these policies did not have negative patient or health-system effects, but resulted in savings of millions of dollars.

Nova Scotia, Saskatchewan and Quebec also use therapeutic substitution in their public drug plans. In 2013, Quebec introduced therapeutic substitution for proton pump inhibitors. In the first six months, Quebec has saved $34.4 million. 

Many other countries use therapeutic substitution, including Australia, Belgium, Denmark, Germany, Italy, New Zealand, the Netherlands, Portugal, Spain, Sweden and various private health-care plans in the United States.

Since 2008, therapeutic adaptation (substitution) is also something pharmacists do routinely in B.C. for certain drug classes, as authorized by the College of Pharmacists of B.C.

Mr. Oliphant claims "therapeutic substitution is not only bad medicine for patients, it's also bad for health care systems."

However, British Columbia has some of the best health outcomes in Canada, and the longest life expectancy at 82 years.

PharmaCare used to be one of the fastest-growing areas of the health-care budget, but B.C's hard work on controlling drug costs has paid off. PharmaCare's budget remained stable at $1.1 billion last year, despite coverage of many new drugs.

A 2010 study from the Canadian Centre for Policy Alternatives notes "British Columbia is often held up as a model for the rest of Canada in terms of pharmaceutical policy and health outcomes." It further notes this is achieved at a lower cost than other provinces, due to British Columbians having the lowest per capita cost for prescription drugs, paying lower prices for drugs, using less medication, and using less expensive options.