Graham Steele: The politics of drug funding decisions

The only impossible job in government is to be Minister of Health. And one of the hardest parts of the job is deciding whether to fund expensive new drugs.

The issue has been in the news recently as Health Minister Leo Glavine considers whether to fund Kalydeco, a cystic fibrosis drug for which the manufacturer is asking $300,000 per patient per year. There are eight Nova Scotians suffering from the cystic fibrosis variant that Kalydeco treats.

The Progressive Conservatives faced the same issue with Avastin in 2008. The New Democrats faced it with Lucentis in 2009 and the Zamboni treatment for multiple sclerosis in 2010.

Glavine will very likely fund Kalydeco, but there will be another expensive drug after that, and another, and another. It won't get easier.

The opposition parties will always call for new drugs to be funded. They have nothing to lose. Like the drug companies, opposition politicians press the government with human stories and those stories are compelling.

Glavine called for the funding of Kalydeco when he was in opposition. Perhaps we saw a glimpse of the opposition mindset when he mused aloud about Nova Scotia breaking with the other provinces and making the Kalydeco funding decision on its own.

This earned a public warning from former deputy health minister Kevin McNamara. It's unwise, he said, for Nova Scotia to break from the national Common Drug Review. Multinational drug companies are tough negotiators, he said, and to break from the national group would play into their hands.

This, in turn, earned a public rebuke for McNamara from Cystic Fibrosis Canada, the national advocacy organization, which pointed out the circumstances around Kalydeco were different from the norm.

You can see already how difficult the politics around a drug funding decision can be.

Considering a drug's effectiveness

Besides cost, a health minister has to consider a drug's effectiveness. Some drugs are a "miracle cure" but usually it's way more complicated than that.

Some drugs help some people, a little bit, some of the time. Some are still in the testing stage. The science of all this can be tough for even an expert to understand and our ministers — such is our system of government — are not experts.

A minister also has to take into account any ongoing price negotiations and any precedent they're setting for other drugs. The big multinational drug companies are well funded, very savvy and tough negotiators. They have experience negotiating with drug plans around the world. They know how to apply political pressure.

We can't be naive about their tactics. For them, it's just business.

The last factor — and the hardest — is basic human compassion. Those suffering from a dread disease, and their families, have little patience for discussions of cost, effectiveness, negotiation or precedent.

Delay may mean more suffering, even death. A new drug offers hope — and what price do we put on that?

Impossible job

When I was the finance minister and sitting on the Treasury Board, we knew how difficult these decisions were for our health minister. When she said yes, we said yes. We weren't about to throw a financial roadblock in her way, but we did have to figure out how to make it work.

We have three major drug programs in Nova Scotia — Seniors' Pharmacare, Family Pharmacare and Community Services Pharmacare — and the budget for these programs is high and rapidly rising.

Every time an expensive new drug is added, it has to be paid for somehow. The cost of new drugs is already crowding out other public services.

The decision about funding new drugs is not a Nova Scotia issue and it is not a party issue.

Every province is facing exactly the same challenges and it doesn't matter who's in charge. That's why we need to give Glavine — or any health minister — plenty of no-politics, no-pressure space in which to decide.

In return, we should expect complete candour about what has been cut to make room for the new drug. Because in the end, those can be the toughest choices of all in an impossible job.