Arthritis Consumer Experts

Arthritis Consumer Experts

April 28, 2009 08:00 ET

Arthritis Consumer Experts: Alberta Government Forcing Rheumatologists to "Flip a Coin" on Medications

Inflammatory arthritis patients fear being denied coverage for gold-standard class of medications

EDMONTON, ALBERTA--(Marketwire - April 28, 2009) - The Alberta government has recently announced very restrictive coverage for rituximab, a medically necessary rheumatoid arthritis medication. Rituximab (Rituxan®) was added to the Alberta Health and Wellness drug benefit list after government came under fire for long delays in listing it, but the criteria for reimbursement is so restrictive that patient advocates and physicians are worried that people with arthritis will fall through the cracks.

Rituximab is part of a class of medications known as biologic response modifiers. Biologics target the causes of inflammation in people living with inflammatory autoimmune forms of arthritis, a group of diseases that can cause devastating joint damage, disability, and even death.

Just like in treatment for HIV, medication treatment for inflammatory arthritis often involves designing a medication cocktail including several different drugs. As biologics work differently in different patients, it is critically important that physicians have access to the full range of medication options when designing a treatment program for a person with inflammatory arthritis.

Rituximab, along with another biologic called abatacept (Orencia®), has been listed on the Alberta medication formulary with the restriction that if a patient fails to respond to either one, they are no longer eligible for reimbursement for any other medication in the class.

"Essentially, if a patient fails to respond to either rituximab or abatacept that patient will be told that they are at the end of the treatment line in terms of reimbursement for biologic treatment, even if there is another medication listed on the formulary that could help that person get better," said Dr. Walter Maksymowych, Professor of Medicine and Heritage Scientist at the University of Alberta.

"This is a frightening example of criteria for reimbursement being made so restrictive that a medication listing is of little to no value for people who need appropriate treatment to survive," said Cheryl Koehn, President of Arthritis Consumer Experts. "Once again, the government of Alberta is failing to consider the full breadth of available evidence, and is listing arthritis medications in a manner not at all consistent with recommendations from the Common Drug Review, or with listings in other provinces."

Dr. Anthony Russell, Professor of Medicine at the University of Alberta, agreed. "Alberta Health and Wellness continues to indicate that in the province of Alberta, arthritis treatment is not a priority," he said. "With this new listing, doctors will be forced to guess which medication will work for their patient, and if they guess wrong, that patient will be out of luck."

About ACE

Arthritis Consumer Experts (ACE) is a national organization that provides research-based joint health information and education to Canadians with arthritis, and monitors the performance of provincial health care delivery to those living with the disease. Through its JointHealth™ series of programs, the organization helps to empower people living with all forms of arthritis to take control of their disease and to take action in health care and research decision making. ACE is led by people with arthritis and its activities are guided by a strict set of guiding principles, and by an advisory board comprised of leading scientists, medical professionals and informed arthritis activists.

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