Wednesday, August 6, 2014

Oh Canada! BC Moves To Cut Off Reimbursesment/Support For Januvia®/Janumet® (Sitagliptin)

Yes, 'tis true -- British Columbia is not. . . all of Canada. Not even remotely (double-meaning plainly, but in good nature, intended -- sorry my more-rural dwelling Canadian friends!). . .

But, it is usually true that when one governmental unit payor, in any government payor-driven system, moves to limit coverage for any drug -- the other payors in the system do tend to. . . take note, and often. . . follow suit. So it is that Merck should be both concerned, and undertaking a strong "ground game" -- inside BC, to get doctors and patients (especially those happy with their sitagliptin regimes) to advocate for its continued viability -- as a reimburse-able diabetes medication.

It will be interesting, in time, to discover whether some of this recent BC decision was driven by the widening availability of SGLT2 inhibitors like Lilly's Jardiance® (empagliflozin -- i.e., no pancreatitis risk), and the associated blood pressure moderations, and at least some weight loss, seen in many Type 2 patients, on the newer class medication. I think we all accept that a significant co-morbidity factor in many late-onset North American diabetes patients is. . . obesity, and high blood pressure. [Invokana®, and the newer Lilly product, each seem to neatly address this co-morbidity.] We shall see -- here is a bit of Merck Frosst Canada's presser, on this luminous August dawn, in the lower 48:

. . . .On July 30, 2014, Merck was advised by the British Columbia Medical Beneficiary and Pharmaceutical Services Division of the delisting of all sitagliptin products from the British Columbia Pharmacare Benefits Program. Effective August 5, 2014, the British Columbia Medical Beneficiaries and Pharmaceutical Services Division is adjusting its coverage of DPP-4 inhibitor drugs; as such, coverage of sitagliptin products will end for all patients on February 5, 2015. Based on Merck's information, the customary consultation from relevant stakeholders, including health care professionals and patients, has not taken place. Merck strongly disagrees with this approach. . . .

Merck supports a patient-centered approach, where the impact on patients is the primary consideration. The choice of treatment options and individualization of treatment are paramount to patient care. Merck remains committed to working with governments and key stakeholders to help manage overall healthcare costs and sustainability, and improve patient health outcomes, by providing competitive pricing for medications and innovative solutions. . . .

While British Columbia may seem a smallish market -- I quite agree that Merck ought to be concerned, any time a flagship franchise's reimbursement is dropped, by any government payor. The thinking here would run "if it sticks in BC, so it might spread to all of Canada. . ." And that's not a particularly warm and fuzzy thought, for Whitehouse Station/Kenilworth. We will keep an eye on it.

[Editorial Note: And. . . that makes. . . an even 3,200 posts. Sweet.]

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