 |
 |
 |
 |
 |
 |
 |
 |
 |
Help Suzanne Aucoin
Sept. 18, 2006 - National Post
'An inefficient system': Suzanne Aucoin has spent more than $52,000 on a cancer
drug that Health Canada approved, but OHIP initially refused to cover. Now she
wants her money back
National Post Monday, September 18, 2006
Page: A13
Section: Body & Health
Byline: Kelly Patrick
Source: National Post
In the three years since her colorectal cancer returned, Suzanne Aucoin has spent as
much time fighting Canada's health-care bureaucracy as she has her terminal illness.
The 36-year-old St. Catharines, woman spent more than $52,000 of her own money on
Erbitux, a cancer drug that is not commercially available in Canada and that Ontario's
health plan, OHIP, initially refused to cover.
Now she is trying to get that money back -- and trying to change the Byzantine
provincial health insurance program that left her responsible for those costs in the
first place.
Ms. Aucoin's case is scheduled to be heard today by Ontario's Health Services Appeal
and Review Board, the panel that handles appeals of OHIP rejections. Ms. Aucoin plans
to testify.
"I am completely disgusted with our health-care system," she said. "I am very
discouraged and frustrated by the lack of professionalism, the lack of consistency and
the lack of care for me as an individual patient."
Ms. Aucoin's ordeal highlights the problems that plague Ontario's -- and Canada's --
approach to making available and paying for expensive cancer medications.
Ms. Aucoin began battling the OHIP system in October, 2005, when her oncologist
recommended she begin receiving weekly treatments of Erbitux.
Health Canada, a federal body, had approved the intravenous drug the month before.
The goal of the treatment was to halt the growth of Ms. Aucoin's stage IV colorectal
cancer, which had spread from her colon to her lungs and liver.
She was first diagnosed in 1999, at age 28.
However, Bristol-Myers Squibb, the pharmaceutical company that produces Erbitux,
had not made the drug commercially available in Canada. At the time, the company had
not jumped through the hoops necessary to sell the drug in 10 different provinces.
The company has since said it does not plan to market the treatment in Canada
because it can't charge the price it wants. Erbitux is available in the United States.
Ms. Aucoin's oncologist applied to OHIP for out-of-country funding for her treatment.
OHIP officials turned down the request because they considered Erbitux experimental
-- despite Health Canada's approval -- and because, mistakenly, they believed Erbitux
was available in Ontario.
Meanwhile, OHIP agreed to pay for 29 other Erbitux users between Jan. 1, 2005, and
February, 2006, which Ms. Aucoin's lawyer, Brian Cohen, discovered after filing a
Freedom of Information Act request.
"That's the great mystery," Mr. Cohen said. "Suzanne has asked her doctor, her doctor
has asked OHIP. Why did they reject her application at the same time they were
approving others for the exact same treatment? Suzanne has never been given an
answer."
Ms. Aucoin appealed the October, 2005, OHIP rejection. But as the case slowly made
its way through the system she was left with no choice but to foot the bill for Erbitux
herself.
By charging weekly treatments to her credit card and using money she raised at
dinners and golf tournaments, the former Catholic school chaplain managed to pay for
two months of treatments at a doctor's clinic in West Seneca, N.Y., at a cost of
$31,065. That is about $4,000 per treatment.
In December, 2005, Health Canada and Bristol-Myers Squibb agreed to a special deal
allowing Ms. Aucoin access to Erbitux at the Hamilton Health Sciences Centre.
Since the drug was not technically available in Ontario, it was not covered by OHIP.
Ms. Aucoin was left with the tab again, but this time the bill was
smaller: $21,182 for three months of Erbitux, or about $1,600 per treatment.
In March, Ms. Aucoin's doctor applied to OHIP a second time for out-of-country
coverage. This time, without explanation, OHIP approved the request.
It agreed to pay for the intravenous medication to be administered at the Roswell Park
Cancer Institute in Buffalo, N.Y., for about $8,000 per treatment.
For the three treatment cycles, OHIP refused to pay $4,000 per treatment at the West
Seneca, N.Y., doctors' clinic, refused to pay $1,600 per treatment at the Hamilton
hospital, but agreed to pay $8,000 per treatment at the Buffalo hospital The province
refuses to reimburse the money Ms. Aucoin spent at the first two locations.
"Whenever I speak to a politician they keep telling me that this problem is because
there's a lack of money and I keep telling them it's an inefficient system," Ms. Aucoin
said.
John Letherby, a spokesman for Ontario's Ministry of Health and Long-Term Care, said
the province's rules about out-of-country funding are hard and
fast: If you receive treatment without getting approval first, you will not be
reimbursed.
In addition, the treatments Ms. Aucoin received in Hamilton would not qualify for
out-of-country funding because they were delivered in the province, he said.
After battling OHIP's complex rules, Ms. Aucoin hopes her appeal will set a clearer
precedent.
"I'm looking to change the system," she said.
kpatrick@nationalpost.com
'An inefficient system': Suzanne Aucoin has spent more than $52,000 on a cancer
drug that Health Canada approved, but OHIP initially refused to cover. Now she
wants her money back
National Post Monday, September 18, 2006
Page: A13
Section: Body & Health
Byline: Kelly Patrick
Source: National Post
In the three years since her colorectal cancer returned, Suzanne Aucoin has spent as
much time fighting Canada's health-care bureaucracy as she has her terminal illness.
The 36-year-old St. Catharines, woman spent more than $52,000 of her own money on
Erbitux, a cancer drug that is not commercially available in Canada and that Ontario's
health plan, OHIP, initially refused to cover.
Now she is trying to get that money back -- and trying to change the Byzantine
provincial health insurance program that left her responsible for those costs in the
first place.
Ms. Aucoin's case is scheduled to be heard today by Ontario's Health Services Appeal
and Review Board, the panel that handles appeals of OHIP rejections. Ms. Aucoin plans
to testify.
"I am completely disgusted with our health-care system," she said. "I am very
discouraged and frustrated by the lack of professionalism, the lack of consistency and
the lack of care for me as an individual patient."
Ms. Aucoin's ordeal highlights the problems that plague Ontario's -- and Canada's --
approach to making available and paying for expensive cancer medications.
Ms. Aucoin began battling the OHIP system in October, 2005, when her oncologist
recommended she begin receiving weekly treatments of Erbitux.
Health Canada, a federal body, had approved the intravenous drug the month before.
The goal of the treatment was to halt the growth of Ms. Aucoin's stage IV colorectal
cancer, which had spread from her colon to her lungs and liver.
She was first diagnosed in 1999, at age 28.
However, Bristol-Myers Squibb, the pharmaceutical company that produces Erbitux,
had not made the drug commercially available in Canada. At the time, the company had
not jumped through the hoops necessary to sell the drug in 10 different provinces.
The company has since said it does not plan to market the treatment in Canada
because it can't charge the price it wants. Erbitux is available in the United States.
Ms. Aucoin's oncologist applied to OHIP for out-of-country funding for her treatment.
OHIP officials turned down the request because they considered Erbitux experimental
-- despite Health Canada's approval -- and because, mistakenly, they believed Erbitux
was available in Ontario.
Meanwhile, OHIP agreed to pay for 29 other Erbitux users between Jan. 1, 2005, and
February, 2006, which Ms. Aucoin's lawyer, Brian Cohen, discovered after filing a
Freedom of Information Act request.
"That's the great mystery," Mr. Cohen said. "Suzanne has asked her doctor, her doctor
has asked OHIP. Why did they reject her application at the same time they were
approving others for the exact same treatment? Suzanne has never been given an
answer."
Ms. Aucoin appealed the October, 2005, OHIP rejection. But as the case slowly made
its way through the system she was left with no choice but to foot the bill for Erbitux
herself.
By charging weekly treatments to her credit card and using money she raised at
dinners and golf tournaments, the former Catholic school chaplain managed to pay for
two months of treatments at a doctor's clinic in West Seneca, N.Y., at a cost of
$31,065. That is about $4,000 per treatment.
In December, 2005, Health Canada and Bristol-Myers Squibb agreed to a special deal
allowing Ms. Aucoin access to Erbitux at the Hamilton Health Sciences Centre.
Since the drug was not technically available in Ontario, it was not covered by OHIP.
Ms. Aucoin was left with the tab again, but this time the bill was
smaller: $21,182 for three months of Erbitux, or about $1,600 per treatment.
In March, Ms. Aucoin's doctor applied to OHIP a second time for out-of-country
coverage. This time, without explanation, OHIP approved the request.
It agreed to pay for the intravenous medication to be administered at the Roswell Park
Cancer Institute in Buffalo, N.Y., for about $8,000 per treatment.
For the three treatment cycles, OHIP refused to pay $4,000 per treatment at the West
Seneca, N.Y., doctors' clinic, refused to pay $1,600 per treatment at the Hamilton
hospital, but agreed to pay $8,000 per treatment at the Buffalo hospital The province
refuses to reimburse the money Ms. Aucoin spent at the first two locations.
"Whenever I speak to a politician they keep telling me that this problem is because
there's a lack of money and I keep telling them it's an inefficient system," Ms. Aucoin
said.
John Letherby, a spokesman for Ontario's Ministry of Health and Long-Term Care, said
the province's rules about out-of-country funding are hard and
fast: If you receive treatment without getting approval first, you will not be
reimbursed.
In addition, the treatments Ms. Aucoin received in Hamilton would not qualify for
out-of-country funding because they were delivered in the province, he said.
After battling OHIP's complex rules, Ms. Aucoin hopes her appeal will set a clearer
precedent.
"I'm looking to change the system," she said.
kpatrick@nationalpost.com