Toronto Star

Drug short­ages may ground Cana­di­ans this travel sea­son

- CHARLES S. SHAVER CON­TRIB­U­TOR Health · Pharmaceutical Industry · Medications · Medicine · Canada News · Industries · Pharmacology · Belgium · Belarus · Canada · Austria · British Columbia · Colombia · Alberta · Saskatchewan · Quebec · New Brunswick · Ontario · Waterloo · Prince Edward Island · Ginette Petitpas Taylor

Many Cana­dian snow­birds may soon be grounded.

As the fed­eral elec­tion ap­proaches, many people will also be mak­ing plans for their win­ter va­ca­tion. Yet due to in­ac­tion by the fed­eral health min­is­ter, some people may be forced to re­main in Canada if drug short­ages now cause them to fail to qual­ify for pri­vate travel in­surance.

Each fall, a num­ber of patients come to my of­fice to fine-tune their med­i­ca­tions. Of­ten, when I am about to in­crease the dose or add a new medication for bet­ter con­trol of di­a­betes mel­li­tus, hy­per­ten­sion, etc., patients will re­mark that they plan to leave for a south­ern des­ti­na­tion in a month or two.

Even a change in dose of med­i­ca­tions could in­val­i­date pri­vate travel in­surance, and cer­tainly a sub­sti­tute to a “close cousin” in the same drug fam­ily would do so. Thus, a large group of people who have been sta­ble for years on var­i­ous med­i­ca­tions face the pos­si­ble loss of in­sur­a­bil­ity.

For many months, well-es­tab­lished drugs have been sud­denly placed on “back or­der” for an un­known pe­riod of time. This in­volves drugs used in can­cer ther­apy as well as sev­eral med­i­ca­tions for hy­per­ten­sion, heart fail­ure, di­a­betes mel­li­tus, heart­burn, tu­ber­cu­lo­sis and seizures. Is this due to in­creased global de­mand, a lack of ac­tive in­gre­di­ents, con­tam­i­na­tion is­sues, vague man­u­fac­tur­ing prob­lems or sim­ply a de­ci­sion to stop mak­ing an un­prof­itable drug? No one will say.

Ac­cord­ing to Kelly Grindrod, as­so­ciate pro­fes­sor of phar­macy at the Uni­ver­sity of Water­loo, 1,800 of 7,000 pre­scrip­tion drug prod­ucts are shorted. A sub­sti­tute drug in the same fam­ily may still have quite dif­fer­ent side ef­fects and reduced ef­fi­cacy. More­over, a forced change in med­i­ca­tions within three months of trav­el­ling can make patients “un­sta­ble” in the eyes of in­surance com­pa­nies.

The Canada Health Act states that “if in­sured per­sons are tem­po­rar­ily out of the coun­try, in­sured ser­vices are to be paid at the home prov­ince’s rate.” Yet for hos­pi­tal care out­side Canada, Bri­tish Columbia still pays only $75 per day. Al­berta, Saskatchew­an, Quebec and New Brunswick pay $100. Un­til Jan. 1, On­tario will pay $200 to $400 per day. Most prov­inces, rec­og­niz­ing that th­ese are mere to­ken amounts, ad­vise people to pur­chase pri­vate travel in­surance; this will be­come in­creas­ingly dif­fi­cult for people whose drugs are changed due to back orders, mak­ing a real catch-22 situation.

The CHA An­nual Re­port 2017-2018 states: “For all ju­ris­dic­tions ex­cept Prince Ed­ward Is­land and the three ter­ri­to­ries, the per diem rate for out of coun­try ser­vices ap­pears lower than the home prov­ince or ter­ri­tory rate, which is con­trary to the re­quire­ment of the porta­bil­ity cri­te­rion of the CHA.”

Fi­nan­cial penal­ties for vi­o­la­tions of ex­tra-billing and user fees are “manda­tory,” whereas those for other vi­o­la­tions such as porta­bil­ity are only “dis­cre­tionary.” The re­port ad­mits that “to date the dis­cre­tionary penalty pro­vi­sions of the Act have not been applied.” Cana­di­ans should de­mand that Health Min­is­ter Ginette Petit­pas Tay­lor in­ves­ti­gate the cause of wors­en­ing drug short­ages and find solutions. In ad­di­tion, af­ter many years of in­ac­tion, she should fi­nally en­sure that all Cana­di­ans re­ceive at least the health cov­er­age out­side their coun­try that is clearly re­quired by the Canada Health Act.

En­forc­ing the CHA will likely cause prov­inces to de­mand in­creased fed­eral health trans­fer pay­ments. Hence, when the health min­is­ters next meet, up­dat­ing and amend­ing the act should be on the agenda so as to make health de­liv­ery more fis­cally sustainabl­e.

By the Oc­to­ber elec­tion, the SNCLavalin af­fair, prom­ises on bal­anc­ing the fed­eral bud­get, voting re­form and avoid­ance of om­nibus bills will prob­a­bly seem less im­por­tant than health access is­sues. The prob­lems de­scribed above will be­come more rel­e­vant as win­ter ap­proaches and — quite likely — even more drugs are sud­denly placed on back or­der. The re­sult? Many people may be de­prived of spend­ing a few weeks in the south due to lack of ad­e­quate health cov­er­age out­side Canada.

Politi­cians should re­mem­ber that most of th­ese af­fected people do vote.

 ?? ADRIAN WYLD THE CANA­DIAN PRESS FILE PHOTO ?? Cana­di­ans should de­mand that Health Min­is­ter Ginette Petit­pas Tay­lor in­ves­ti­gate the cause of wors­en­ing drug short­ages, Dr. Charles Shaver writes.
ADRIAN WYLD THE CANA­DIAN PRESS FILE PHOTO Cana­di­ans should de­mand that Health Min­is­ter Ginette Petit­pas Tay­lor in­ves­ti­gate the cause of wors­en­ing drug short­ages, Dr. Charles Shaver writes.
 ??  ?? Dr. Charles S. Shaver is past chair of the Sec­tion on Gen­eral In­ter­nal Medicine of the On­tario Med­i­cal As­so­ci­a­tion.
Dr. Charles S. Shaver is past chair of the Sec­tion on Gen­eral In­ter­nal Medicine of the On­tario Med­i­cal As­so­ci­a­tion.

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