FH Canada Patient Network 151 Bloor St West, Suite 600, Toronto ON M5S 1S4
Tel: (416) 969-7464 http://www.fhpatientcanada.org
TheHonourableTerryLakeMinistryofHealthPOBOX9639STNPROVGOVTVictoriaBC,V8W9P1DearMinister,IamwritingtoyouonbehalfoftheFHCanadaPatientNetwork(FHCPN)tourgeyourimmediateattentiontocorrectingapuzzlinganomalythatisaffectingthewell-beingandlivesofpatientswithprimaryandfamilialhighcholesterol.ThisissuecametoourattentionwhentheFHCPN,astheonlypatientdrivenorganizationforfamilialhypercholesterolemiainCanada,waspreparingoursubmissiontotheCommonDrugReviewcommentingontwonewtherapies(PCSK9).OursurveytoFHpatientcommunityconfirmedwhatiswellknown:forthemajorityofpatientwithhighcholesterol,familialandnonf-familial,statinsworkverywellinmanagingLDLcholesterol(LDL-C,theharmfulor“bad”cholesterol)tolevelsthatprotectagainstheartdiseaseandstrokes.Forthosewhoweremoreresistant,theadditionoforchangetoezetimibewaseffectiveinachievingtargetLDL-Clevels.TheanomalyinourfindingswasthatrespondentsfromQuebecandBritishColumbiaweremorelikelytoreportthattheirLDL-Cwasnoteffectivelymanageddespitetheircurrentdrugtherapies.QuebecweunderstoodbecauseofthehighprevalenceofFamilialHypercholesterolemiainthosewithFrenchheritage.BritishColumbiawedidnotunderstanduntilphysiciansenlightenedustothefactthatezetimibe(Ezetrol)wasnotontheBCformulary.Incontrasttootherprovinces,Ezebrolcanonlybeaccessedthroughthepublicdrugplanthroughaspecialauthorizationprocess.Notonlyistheprocesscumbersomebutthedrugisoftendenied,whichreducesmotivationtoprescribebutmore,importantly,reducesaccessbypatientswhoareinneed.InApril2016,atourFHpatientforuminVancouver,physiciansalsospoketoglobalevidencewhichshowedthatby”loweringLDL-Cfurther,ezetimibesignificantlyreducesmajorcardiovasculareventsincludingheartattack,strokeandcardiovasculardeathwhenaddedtoastatininindividualsathighriskforcardiovasculardisease.” According to treatment guidelines, ezetimibeisindicatedforpatientswithveryhighcholesterol(oftenduetogeneticandnotlifestylefactors)forwhomthehighestdosagesofstatintherapyareinsufficient,aswellasthose(upto20%)ofpeoplewhogetintolerablesideeffectsfromstatins,sotheycantakenostatinsornotahighenoughdosagetolowercholesteroltosafelevels.
FH Canada Patient Network 151 Bloor St West, Suite 600, Toronto ON M5S 1S4
Tel: (416) 969-7464 http://www.fhpatientcanada.org
Paradoxically,becauseEzetrolisnotlistedontheBCformulary,thereisnorequirementthatthegenericformofezetimibebeprovidedat25%orthebrandprice,whichwouldactuallyresultinasignificantcostsavings.BynotlistingEzetrol,BCisforcingphysicianstoexpendtimeandeffortonunnecessarybureaucraticprocess,keepingthepriceofezetimibetherapyhigherthannecessary,and,mostimportanty,reducingaccesstolife-enhancingandlife-savingtherapyformanyBCpatients.WeurgeyoutocorrectthisdeficiencyintheBCdrugplanassoonaspossible.Astheonlypatient-drivenorganizationdedicatedtohighcholesterolandhighlipids,wewouldbemostpleasedtoworkwithyouonthisandotherissuestoimprovethecost-effectivenessofthehealthcaresystemandthelivesofall. Sincerely,
DurhaneWong-Rieger,PhDChair,FHCanadaPatientNetwork151BloorStreetWest,Suite600Toronto,OntarioM5S1S4(416)969-7435or(647)[email protected]:BarbaraWalman,ADMPharmaceuticalServicesDivisionEricLun,BCPharmaceuticalServicesDirector
