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HALIFAX - Canadian rheumatologists are caught between a rock and a hard place.
While new biologics have the potential to take some of their worst rheumatoid arthritis patients from the wheelchair to the dance floor, high cost and red tape are hampering these efforts. To make matters worse, many patients who have tasted the dance--who had access to it under a special pre-marketing program--are now faced with disability all over again.
"I've had patients who've called crying, saying 'They can't make me go back to the way I was,' " said Dr. Dianne Mosher, a Halifax rheumatologist and president of the Canadian Rheumatology Association.
At the centre of the access controversy is infliximab (Remicade). The Remicade story reminds government, industry and doctors of the need to sort out access problems as new, exciting and expensive medications explode onto the scene.
"Price tags are going up for all diseases. How is society going to deal with that? asked Dr. Mosher.
Remicade is indicated for moderate to severe rheumatoid arthritis and Crohn's disease. Treatment for the average RA patient costs $18,000 a year. Before it was approved for sale in Canada, Remicade was provided free of charge to thousands of patients by Schering Canada Inc. under a special access program set up by Health Canada. This happens with many new drugs, but what Schering didn't know was that it would take another two years for the drug to be approved.
Altogether, Schering spent $55 million on the special access program, which ended in the summer of 2001.
Now that Remicade is on the market, new accessibility problems have arisen. The provincial formularies are reluctant to list it (so far only Saskatchewan has listed...