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'Typical Process' Followed in Decision to Fund Anti-Smoking Drugs, Ministry Says

Docs released through FOI show premier's campaign vow played key role.

By Andrew MacLeod 19 Jun 2015 | TheTyee.ca

Andrew MacLeod is The Tyee's Legislative Bureau Chief in Victoria and the author of A Better Place on Earth: The Search for Fairness in Super Unequal British Columbia (Harbour Publishing, April 2015). Find him on Twitter or reach him here.

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Ministry says decision to fund drugs based on 'rigorous review of clinical evidence.' Pill photo via Shutterstock.

A British Columbia health ministry spokesperson says the decision to fully fund prescriptions for controversial anti-smoking drugs followed the government's "typical process," despite documents that show the decision hinged on a campaign promise made by Premier Christy Clark.

"The ministry bases its drug-coverage decisions for PharmaCare on a rigorous review of clinical evidence, to ensure PharmaCare is consistently covering the most beneficial drugs for patients," said an emailed statement from the ministry spokesperson. "The ministry followed its typical drug coverage decision process for both Champix and Zyban."

As The Tyee reported this morning, a "decision briefing note" released on the government's open information website detailed the factors considered in deciding whether or not the province should pay for the full cost of anti-smoking treatments through the public PharmaCare drug plan.

The briefing note gave prominence to the fact that Clark had already promised the province would pay for the treatments.

The products under consideration for funding in the note included two prescription drugs: varenicline, sold as Champix by Pfizer Canada Inc.; and buproprion, sold as Zyban by GlaxoSmithKline. Around the time B.C. began paying for varenicline, France stopped paying for the drug due to questions about risks to users.

The Sept. 30, 2011 briefing note prepared for the executive director of drug intelligence for the Ministry of Health, Eric Lun, explained two options for the province: paying for the drugs and nicotine replacement products, or not paying for them.

The option that considers not paying for them says, "Con: This option limits the smoking cessation options available to residents of B.C. and would be inconsistent with the Premier's announcement regarding smoking cessation."

The reasons in favour of paying for the treatments are that it would be "consistent with the Premier's announcement and expands treatment options."

Promise made, promise kept

Clark first promised to fund anti-smoking treatments during her campaign to lead the BC Liberal Party, which she won in February 2011. After becoming premier she repeated the promise in May 2011, more than four months before the health ministry decided to fund the drugs.

The discussion section of the briefing note document says a 2007 recommendation by the Canadian Expert Drug Advisory Committee, a 2010 report from the Canadian Agency for Drugs and Technologies in Health, and a 2011 recommendation from the Drug Benefit Council supported paying for the drugs.

Before a drug can be covered by PharmaCare it needs approval from Health Canada, a recommendation from the national Common Drug Review, and a review by B.C.'s Drug Benefit Council, the ministry spokesperson said. "After all these steps, the ministry looks at PharmaCare's general policies on what is covered, and whether the ministry has the resources to cover the cost of the drug, and then makes a final decision."

The government's briefing note shows the decision to pay for anti-smoking drugs was political, not based on evidence, said health policy researcher and author Alan Cassels. "It's got the camouflage of a science-based decision, but clearly the recommendation is, 'Let's do this because the premier's already announced it.'"

B.C.'s anti-smoking program has never had an independent evaluation, and the government has no idea whether it is succeeding at helping people stop smoking, Cassels said.

Evaluation coming

When Roderick MacIsaac was fired as a health ministry co-op student along with six other ministry employees in 2012, he had been designing a way to evaluate the program. MacIsaac killed himself a few months after losing his position, and Clark has apologized to his family for the "heavy handed" firing.

In 2013, the government blocked the Therapeutics Initiative at the University of British Columbia from looking at the anti-smoking program, The Tyee has previously reported.

Ministry staff decided in 2012 not to have the Therapeutics Initiative look at the program since the government had earlier sought independent research on the topic from the Canadian Institutes of Health Research Drug Safety and Effectiveness Network, the statement from the ministry spokesperson said.

Like other studies, that study found the two prescription drugs are effective and safe, the statement said. "The study found Champix and Zyban used for smoking cessation did not increase instances of treated depression, anxiety or self-harm."

The health ministry is now evaluating the anti-smoking program to see if it helps people quit smoking, with results expected later this year, according to the statement.

"The evaluation includes a participant survey that looks at smoking behaviours before and after the program," the statement said. "It also includes an evaluation, using health system data, of the program's effect on rates of quitting and attempted quitting, and whether the program decreased smoking-related illnesses and/or smoking-related use of health services."

Since the program began, 187,000 people have used it, with roughly 107,000 receiving a nicotine replacement therapy, 68,000 receiving Champix, and 12,000 receiving Zyban.  [Tyee]

Read more: Health, BC Politics

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