Government-forced medication switching: A new threat to 50-plus Canadians

New Federal policy on Proton Pump Inhibitors draws strong opposition from medical experts and could represent a dangerous precedent affecting the increasing number of 50-plus Canadians.

A new cost-cutting measure is forcing thousands of First Nations and Inuit Canadians with severe gastrointestinal problems to stop taking the medication that is working for them. They must replace it with a cheaper drug that, according to Health Canada, is not equivalent to the one that is working. Medical experts strongly oppose this new policy, (otherwise known as therapeutic substitution), and CARP, Canada’s Association for the Fifty-Plus, is concerned that it might set a precedent for many other health conditions, and in other jurisdictions. It is therefore an issue that is very seriously affecting the 50-plus population. CARP urges you to read this report, get all the facts, and then contact your Federal MP through CARP E-Voice.

What’s going on?
A recent policy change by the Non-Insured Health Benefits (NIHB) directorate of the First Nations and Inuit Health Branch of Health Canada will force doctors to substitute dication for patients with severe gastrointestinal problems with a lower- priced drug – which may not provide the same quality of treatment and symptom relief.

Medications called Proton Pump Inhibitors (PPIs) are now used to treat serious gastrointestinal problems caused by acid reflux disease, and to prevent long-term severe complications. The new policy forces patients who have had their symptoms stabilized by this effective therapy to switch to a cheaper PPI medication, which has not been approved by Health Canada as a generic substitute.

The new medicine that patients are being forced to take is not a generic version of their existing medicine, but a different medication composed of a different chemical compound.

What do the experts say?
“It has been documented that such a forced-switch approach will incur patient suffering, additional healthcare costs (in physician visits at both primary care and specialist levels), and serious adverse clinical outcomes,” says Dr. Des Leddin, President of the Canadian Association of Gastroenterology (CAG).

According to the Canadian Society of Intestinal Research, a similar policy in British Columbia caused 25% of patients forced to switch their PPI medication to experience treatment failure and serious side effects including diarrhea, vomiting, nausea, headaches, chest pain, fatigue, and even gastric bleeding.

“It does not make economic sense to limit access to a medication that controls a serious disease today, then to pay thousands of dollars tomorrow for the consequences of a disease run rampant,” says Gail Attara, Executive Director for the Canadian Society of Intestinal Research and spokesperson for the Best Medicines Coalition, a national group of health-related charities. “Savings are short-sighted when drug expenses are reduced because this increases demand on hospital, diagnostic, and physician services, and these expenditures are even more costly in the long-run.”

Other experts agree. “Switching thousands of patients, from an established effective therapy will have potentially profound effects, ranging from inconvenience and annoyance, to at worst failed therapy, deterioration, and unnecessary complications resulting in suffering and increases in physician, pharmacist and hospital services.” says Russell Williams, President of Rx&D, Canada’s Research-Based Pharmaceutical Companies.

“Given that the principle behind therapeutic substitution strategies is fundamentally unfair to patients,” Williams adds, “Governments should be very cautious when making clinical interventions motivated primarily by budgetary needs.”

What does CARP say?
CARP maintains that physicians should not be compromised in their responsibility for patient care and the manner they deem appropriate to treat patients. No healthcare provider should come between the doctor and patient by mandating one treatment over another.

P>“Therapeutic substitution does not recognize that each patient responds differently to the same medication and one medication does not fit all,” says Lillian Morgenthau, President and Founder of CARP. “This principle affects the patient/doctor relationship. Doctors must have the ultimate responsibility for patient care.”

Further, it is dangerous to remove a working medication for a patient and force them to adapt to a new program, especially when you consider that many seniors are frail and may not respond well to sudden changes in their medication. Indeed, it could make them more ill and cause other health implications, which would further burden the system.

A dangerous precedent?
The federal government may be breaking dangerous new ground with this policy of forced substitution of one medication for another with a similar, but not identical, performance. This is not a generic substitution, where the patient receives a generic form of the medication after the brand name patent expires. Instead, patients are being forced to take a uniquely patented drug of a different chemical composition in place of their medication.

“We are concerned that the PPI class of drugs is only the beginning,” cautions Attara, “And that government will soon pursue even greater cuts to the drug budget by turning its attention to other classes of important medications – for cholesterol, arthritis, mental illness, and on and on, which could cause negative Canada-wide health consequences.”

What can you do about it?
This is an issue, which affects all Canadians, particularly the 50plus. If you share our concern with this dangerous precedent-setting policy – which could encourage other drug plans to implement their own policy of forced medication-switching – please contact your federal MP immediately through CARP E-Voice, and urge that this new policy decision be reversed. If you don’t speak up now you might find yourself down the road without access to a medication that you need.

This Special Educational Feature was produced by the editors of CARP magazine through an unrestricted educational grant.