Provincial Disparities of Growth Hormone Coverage for Young Adult Survivors of Paediatric Brain Tumours across Canada

Abstract

Background: Young adult survivors of paediatric brain tumours (PBTs) who have been treated with radiation therapy will likely be severely growth hormone-deficient when retested at the achievement of final height. Growth hormone replacement therapy (GHRT) is administered to treat growth hormone deficiency (GHD). Public drug coverage for GHRT falls under the responsibility of provincial governments across Canada. This study sought to determine the extent of public drug coverage and cost in each Canadian province for GHRT to treat GHD during adulthood for young adult survivors of PBTs. Methods: Data were collected from provincial government resources and drug formularies from 2012-2013 on the extent of coverage for GHRT based on a clinical case scenario representative of a young adult survivor of a PBT with childhood-onset radiation-induced GHD, the ingredient cost for GHRT and the applicable provincial public drug plan cost-sharing policies. A model was then created to simulate out-of-pocket costs incurred by a young adult male and a young adult female survivor of a PBT for one year of GHRT in each province with applicable cost-sharing arrangements and levels of low annual individual total income that best represent the majority of young adult survivors of PBTs. Out-of-pocket costs were expressed as a percentage of annual income. Comparisons were made between provinces descriptively, and variation among provinces was summarized statistically. Results: Alberta, Manitoba, Ontario, Quebec, New Brunswick, and Newfoundland and Labrador provide coverage for GHD during adulthood on a case-by-case basis, while British Columbia, Saskatchewan, Nova Scotia and Prince Edward Island provide no coverage. The percentage of annual income to fund GHRT across the provinces without public coverage ranged from 14.4% to 25.5% for males and 21.5% to 38.3% for females, and with public coverage was 0.0% to 4.1% for males and 0.0% to 5.0% for females. Interpretation: There are considerable out-of-pocket costs and variation in coverage provided by provincial public drug plans to fund GHRT for young adult survivors of PBTs with GHD. The implementation of a national drug formulary could potentially prevent undue financial hardship and remove disparities resulting from variations in provincial drug plans.

Public prescription drug plan coverage for antiretrovirals and the potential cost to people living with HIV in Canada: a descriptive study

“…Our finding of heterogeneity in Canada's public drug programs is consistent with prior work; however, the differences across jurisdictions found in other reviews were attributed to the lack of programs for certain subpopulations, 8 drug costs not exceeding the required premiums or deductibles to receive assistance, 7 or differences in formulary listing. 9 In contrast, while we found that all jurisdictions listed most antiretrovirals and, with the exception of Newfoundland and Labrador, each had a program to provide coverage for all subpopulations, the main differences in coverage were due to variations in the amount of individual subsidies based on criteria. In 6 jurisdictions, antiretrovirals were fully covered with an HIV diagnosis being the only requirement for eligibility aside from having provincial/territorial health coverage; in the remaining regions, income Research and age primarily determined the subsidy received.…”

“…Consequently, Canadians with identical prescriptions may pay substantially different amounts and may rely on private insurance, public funders, out-of-pocket payments or a combination of these to pay for their medication. [7][8][9] Financial burdens are associated with medication nonadherence. 10 Research indicates that medicine costs sometimes compete with other demands, leading to cost-related nonadherence: patients may forego prescribed medications in favour of spending their resources on other priorities or they may alter a medication's dosing to make a prescription last longer.…”