A team of researchers, including BCCOP members Dr. Sonia Singh, Dr. Raheem B. Kherani, Larry Funnell and Irmgard Matthes, are working on spreading the idea of Fracture Liaison Services (FLS) across BC. FLS is a cost-effective evidence-based model that has been adopted worldwide. FLS involves a dedicated coordinator who works with the patient during the orthopedic care for a fracture and links them to their family doctor to follow up on their recovery and prevention. At this time, only three hospitals in the province have implemented FLS.
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: