Island woman says catastrophic drug plan misleading

Ryan Ross
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Sandra Bruce holds up a bottle of pregabalin, which she takes for her fibromyalgia and isn't covered by the province's catastrophic drug plan.

When Sandra Bruce heard the P.E.I. government was starting a catastrophic drug plan she hoped her $600 a month fibromyalgia medication would be covered.

It wasn't.

Now she's trying to get it added to the provincial formulary and says calling the plan a catastrophic drug program is misleading.

"That's a lie."

Bruce didn't always have trouble paying for her medication because her husband had medical coverage through his work and later through Holland College after he went back to school.

Since then they have both been out of work and despite taking a generic version of the drug pregabalin that costs $250 a month, Bruce still struggles to pay for the medication.

The provincial catastrophic drug plan puts a cap on how much Islanders will spend on medication based on their family income, as long as they aren't covered by any of the government's other drug plans.

To qualify, a drug has to be included in the provincial formulary, which pregabalin isn't.

In a statement from a Health and Wellness Department spokeswoman, she said pregabalin isn't covered for fibromyalgia in any of the Atlantic provinces and after a review process, it has not been recommended for the condition.

Since 2013, when the catastrophic drug program was announced, the province has added 33 new drugs to its formulary, including 8 this year.

The spokeswoman said the department will continue to review medications that can be added to the list of publicly-funded drugs based on the advice of experts.

Bruce said without pregabalin she would be in bed all the time and she has been trying different medications to see if anything else will work, but has been unsuccessful.

"It's just been a huge headache."

After applying to have her medication paid for and finding out it wasn't covered, Bruce said she thinks Islanders need to know the program isn't as comprehensive as it sounds.

In her case, Bruce said the government needs to support people who are sick and falling through the cracks.

"I've got nowhere to turn."

rross@theguardian.pe.ca

twitter.com/ryanrross

Organizations: Holland College, Health and Wellness Department

Geographic location: P.E.I.

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Recent comments

  • Debbie Gamble
    March 24, 2014 - 09:54

    Like Sandra Bruce, I am flummoxed by the guidelines used in the Catastrophic Drub plan; it certainly needs some SENSIBLE tweaking. I am a 60-year old woman, on disability from a car accident, and also a Type II diabetic. Although the Drug Formulary for the Catastrophic Drug Program says that the type of test strips I use in my blood glucose meter ARE covered, I find out AFTER the fact that they are only covered 1) IF I am on insulin (I'm not; am on pills) and 2) IF I'm 65 or over. This is LUDICROUS! Test strips are quite expensive: a box of 100 strips is $85. If you are testing 4 times (or more) a day, the cost can be prohibitive. I know of many diabetics who do NOT test their blood, or do not test as many times as they are supposed to, simply because they cannot afford to buy the strips. Where is the sense in this reasoning by the Drug program decision makers? Regular blood glucose monitoring (coupled with diet, exercise and controlling drugs) are major factors in preventing diabetes from worsening. Where is the sense in covering insulin and test strips (which can reach $600 a month or more) for full-blown diabetics, but not the test strips for those of us under 65, who aren't on insulin, to assist us in preventing the disease from worsening -- thereby costing the government MORE per person? Like I say: I'm flummoxed at the reasoning. Come on, people!! It's time to start using some sense in the administration of this drug program!

  • No Idea
    March 14, 2014 - 20:55

    The Atlantic provinces may have indicated that this drug was not for use with FM but that's not the case elsewhere. It's used outside this region to treat the condition. So it sounds more like a case where they are trying to limit costs by denying that this is a viable treatment. Those that think someone with a chronic condition shouldn't get assistance might want to walk a mile in her shoes. Conditions like this can easily destroy someone's life as well as their family. If it was you or someone you loved, you'd want everything available to be done. I'm lucky to be as healthy as a horse and have no issue at all with my tax money going to help someone else have a better quality of life. It disgust's me that people would criticize someone who is vulnerable because they are asking for a little assistance.

  • Vernon
    March 14, 2014 - 14:43

    The public plans should not cover every medication that exists - some of it is approved by Health Canada as "safe" but not as "effective." This is a medication that fits that category - there isn't enough medical evidence to suggest it's effective globally for the disease to warrant the cost.

  • The Observer From Stratford
    March 14, 2014 - 11:13

    It's not a lie. The drug is not recommended for her condition. Why would she think it would/should be covered? I'd also wonder why a doctor would prescribe a drug that is not recommended for this illness.

  • Resident Islander
    March 14, 2014 - 05:33

    Fibromyalgia is not a "catastrophic illness" nor has the medical community even come to a consensus as to whether it really exists.

    • No Idea
      March 14, 2014 - 10:48

      Clearly you haven't had this condition or know anyone who does. I have experience with a friend who does and you have no idea what you're talking about. When you can't get out of bed for days, work or have a normal life due to FM, it's very catastrophic. I can't stand people like you who feel you have some right to knock down others when they are already struggling to get by. Do you get some pleasure out of your superiority complex? God help you when the day comes when you need the kindness of others when your health turns for the worse. I've said this before here. If you have an issue more than a normal case of the flu in PEI, then it's time to leave and get proper health care somewhere else that has real health services.

    • Your an idiot!
      March 14, 2014 - 11:59

      Resident Islander? Have you ever experienced Fibromyalgia first hand? Didn't think so get your facts straight and spend a few days in the body of a person that has the illness then come back and tell me that it doesn't exsist or it isn't catastrophic.. its debilitating pain day in and day out, sometimes it hurts to breathe or even think every portion of your body hurts even your hair!!! People need to stop judging people on blind illnesses just because i don't look sick on the outside doesn't mean i don't fight a daily battle within myself!!!

  • Cornwall Resident
    March 13, 2014 - 18:06

    "The provincial catastrophic drug plan puts a cap on how much Islanders will spend on medication based on their family income, as long as they aren't covered by any of the government's other drug plans." This isn't true, I'm a senior and the money I pay for my drugs goes toward what I have to pay.