Cancer patient fights Ont. government for at home chemotherapy costs

When Greig Derry was diagnosed with stage four colorectal cancer three years ago, he knew he was in for a fight. What he didn’t expect was to have to fight the government of Ontario as well, over paying for his treatment.

“People who are ill, in battles for their lives, should never have to do battle with the bureaucracy,” Derry said. “The healthcare system should instead be coming to the aid of the ill patient, offering options.”

An alternative option is what Derry was looking for when his lesions continued to grow, despite receiving intravenous chemotherapy in-hospital.

Given Derry’s background in integrative therapy, he asked his oncologist if he could lower his dose of chemotherapy safely. His oncologist prescribed him Xeloda, a chemotherapy pill he could take at home.

“Never did I think for a minute that the issue would be whether or not I was going to pay for the drugs. I was more concerned about whether or not I was going to be able to get my oncologist onboard with the concept,” Derry said. “He actually was fine with the concept and sort of told me as I was going out the door and by the way you’ll to have to pay for this and I went ‘You’ve got to be kidding me.’”

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Usually in-hospital chemotherapy treatment comes in intravenous form and takes place in a chemotherapy suite. It is generally covered either by the hospital itself or Cancer Care Ontario. But that isn’t always the case when it comes to coverage for prescription drugs taken at home.

“When they go to a pharmacy and they receive an out-patient prescription it’s like any other prescription in Ontario and all prescriptions in Ontario are not paid for by the government,” said Dr. Leta Forbes, chief medical director of oncology at Lakeridge Health.

Derry estimates he is paying $400 a month for his pills. The drug company had already given him a 25% discount. He wants to know why he’s paying at all. He says he’s freeing up space in the chemotherapy suite and saving the system money by freeing up resources in hospital.

“There’s something seriously broken and deficient about a healthcare system that is undergoing cutbacks in care to save money and reducing access to diagnostic testing to save money and looking for ways to care for patients outside the hospital environment to save money,” Derry said. “But it still makes patients pay instead of saving millions at the stroke of a pen.”

In fact, a 2009 report for the Ministry of Health addressed possible cost savings.

“Based solely on drug costs, the CAPOX (or Xeloda) regimen costs significantly more than the FOLFOX (or intravenous) regimen.  However, because … Xeloda is taken orally and does not require intravenous administration, hospital/clinic resources that would otherwise be utilized could be freed up and reallocated for other intravenous therapies,” said the report.

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Some prescription chemotherapy drugs taken at home can be covered under government programs such as the Ontario Drug Benefit (ODB) program, according to Minister of Health Deb Matthews.

“We have significantly expanded access to cancer drugs and it’s important that people get these drugs, so that’s why we do support them through the ODB and the Trillium Drug Plan,” Matthews said.

Many oral drugs are not be covered by any of these assistance programs. With the number of oral therapies increasing, it’s a problem Dr. Forbes thinks the government will need to address.

“I think a decision to have oral therapy at home can sometimes unfortunately depend on whether or not they can afford the pills and I think that may be something that the system’s going to have to work on for the future,” Dr. Forbes said.

Derry says he was lucky because he was willing to fight.

“I know that if I hadn’t yelled, screamed and been a major pain to somebody that nothing would have happened,” Derry said. “I would have gone home and I would have slowly generated debt.”

While he was rejected previously, he has now been granted coverage for the drugs he’s using under the Exceptional Access Program administered by the Ministry of Health. He credits his local MPP, John O’Toole.

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“I can tell you from first-hand experience that the protocol for obtaining approval as an exceptional case under the EAP is highly discretionary, woefully inadequate and extremely slow,” Derry said. “I suspect that John’s staff probably gave somebody an incentive somewhere along the line to move a little faster.”

But he’s still worried about how many others could be facing the same situation.

“I still have serious concerns and worries for the thousands of folks who came before me and those who will come after me, who will simply be told that their drugs are not covered and will go home under the same financial stress and fear for their future as I have experience first-hand, believing they may never get the coverage they need,” Derry said.

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