Update January 17, 2023
Representatives of BCCOP, Osteoporosis Canada, and MedAccess BC, advocated for the BC Ministry of Health to review PharmaCare criteria for osteoporosis treatment, requesting for improved access to treatment for patients (read here). After a review, the Ministry of Health released a decision on January 17, 2023 to provide coverage for use of denosumab in women with breast cancer taking aromatase inhibitors without a documented fracture (primary prevention). While the updated coverage for use of denosumab in breast cancer patients on AI is welcome news, BCCOP is disappointed with the Ministry's decision to decline coverage for:
Oral bisphosphonates (alendronate and risedronate) in patients with no documented fracture (primary prevention), but considered at high risk of having a fracture
Denosumab in men with prostate cancer, taking androgen deprivation therapy without a documented fracture (primary prevention)
Denosumab in patients with an estimated glomerular filtration rate (eGFR) < 30 mL/min, and a documented fragility fracture (secondary prevention)
The Ministry's decision to reject coverage for the three criteria above means that patients will continue to lack access to PharmaCare coverage of osteoporosis treatment unless they suffer a fracture. Patients with chronic kidney disease with eGFR < 30 will not have access even with a fracture. The literature reviews which led to these rejections were done by the Therapeutics Initiative, a BC government funded body, who delegated the task to non-clinicians. This decision is different from recent decisions by Pharmacare to loosen criteria for more effective (and more expensive) medications for diabetes. Pharmacare will cover the cost of continuous blood glucose monitoring (over $4000 per year) but finds denosumab for osteoporosis patients ($800 per year) too expensive.
The decision to reject these criteria was also made despite a Ministry survey of 362 patients, 24 caregivers, and one patient group highlighting the detrimental health impacts of osteoporotic fractures, and patient/caregiver raised concerns regarding access to denosumab due to cost. BC continues to lag behind the rest of Canada in coverage of osteoporosis treatments, and may be regarded as the one of the provinces with the most restrictive access (see article here, showing BC scoring the lowest out of 7 provinces for access to treatment).
Further advocacy for our osteoporosis patients is definitely required.
Links to the full decision summaries from PharmaCare are provided below:
Decision summary for oral bisphosphonates in primary prevention
Decision summary for denosumab in women with breast cancer on aromatase inhibitors and in men with prostate cancer on androgen deprivation therapy (primary prevention)
Decision summary for denosumab in patients with eGFR < 30 for secondary prevention
A narrative on Fracture Liaison Service (FLS) initiatives in BC
Click here or on image to see article
*shared with permission from publisher
The role of osteoanabolic agents in the management of patients with osteoporosis.
McClung MR, Rothman MS, Lewiecki EM, Hanley DA, Harris ST, Miller PD, Kendler DL.
Postgrad Med. 2022 Aug;134(6):541-551. doi: 10.1080/00325481.2022.2069582. Epub 2022 May 30.
PMID: 35635798 Review.
Denosumab in the Treatment of Osteoporosis: 10 Years Later: A Narrative Review.
Kendler DL, Cosman F, Stad RK, Ferrari S.
Adv Ther. 2022 Jan;39(1):58-74. doi: 10.1007/s12325-021-01936-y. Epub 2021 Nov 11.
PMID: 34762286 Free PMC article. Review.
BC Coalition of Osteoporosis Physicians
The British Columbia Coalition of Osteoporosis Physicians (BCCOP) was formed in 2018 to address deficiencies in osteoporosis care. The coalition brings together BC physicians, and allied health professionals, interested in representing patient care needs to those agencies responsible for making decisions on access to care. We collaborate with Osteoporosis Canada and others with similar agendas. Our funding is from government and health authority sources.