Doctors warn patients could lose access to their medication due to Quebec health-care reform

Patients with rare diseases or cancers could possibly lose access to their treatment because of certain provisions included in the health network reform proposed by Minister Christian Dubé.

Representatives of the Association of Councils of Physicians, Dentists and Pharmacists of Quebec (ACMDPQ) raised the concern Thursday during their appearance before a parliamentary commission.

Toward the end of his presentation, the president of the association, Dr. Martin Arata, stated that article 336 of Bill 15 "modifies access to medication" and that it would have the effect that a patient would no longer be able to access a treatment that "has not received a therapeutic value authorized by (the National Institute of Excellence in Health and Social Services)."

He added that if this provision were currently in effect, "many patients would not have access to chemotherapy treatments, treatments for orphan diseases in pediatrics," he gave as an example. Dr. Arata estimated that in the last two years, at the CHU de Québec alone, more than 40 patients with cancer or pediatric diseases would not have had access to their medication.

When reacting to the presentation and questioning CAGPQ members, Dubé did not address the issue. Instead, the health minister questioned the speakers on the role of physicians, the organization of work, and interdisciplinarity.

Moments later, in an exchange with Québec solidaire MNA Vincent Marissal, Dr. Jean Beaubien revealed that he had just emailed colleagues -- while the commission was running late -- to approve medication for a lymphoma patient.

"There was a recommendation, a therapeutic refusal of the INESSS, in 2021, on this drug for this indication," explained the anesthesiologist and vice-president of the ACMDPQ. Since then, there is new literature and there is an indication or a possibility to give it.

In the current practice, if the use of a drug has not been recommended by the INESSS, but the pharmacological committee of a hospital has seen new favourable scientific literature, it can decide to go ahead and administer the treatment to the patient.

According to what the association denounces, it is the addition of a single sentence in section 336 of the bill to make the health and social services system more efficient that changes everything.

In the new version of the law, they seem to want to keep this margin of the workforce granted to institutional physicians and pharmacists, except that section 336 states that: "The committee may not grant its authorization if the National Institute of Excellence in Health and Social Services has, in an opinion to the minister, refused to recognize the therapeutic value of the medicinal product for the therapeutic indication for which authorization is sought."

"It is precisely this new passage that we wish to see disappear," confirmed Dr. Beaubien in an email to The Canadian Press.

If the INESSS issued an opinion in 2020, for example, and new scientific literature now supports the administration of the drug, the committee cannot grant authorization," he said.

For his colleagues and himself, this is a loss of agility since the scientific literature is improved every day while the recommendations of the INESSS or Health Canada take a long time.

According to Dr. Beaubien, this is especially true in oncology, where research is evolving rapidly and the ways of treating cancers are becoming increasingly personalized.

The minister's office is keen to point out that "the bill can be improved," as Dubé has repeated several times. They also assure that in the example submitted by Dr. Beaubien, a treatment with a new indication that has not been re-evaluated by the INESSS could be prescribed.

The Canadian Press attempted to obtain the position of the Association des pharmaciens des établissements de santé du Québec (APES), which is directly affected by this change. In a written response, the association indicated that it preferred to reserve its comments for its scheduled May 23 testimony before lawmakers.

This report by The Canadian Press was first published in French on April 21, 2023. The Canadian Press health content receives funding through a partnership with the Canadian Medical Association. The Canadian Press is solely responsible for editorial choices.