The price of living pain free: The high cost of psoriasis treatments in Canada

By Lindsay Bright

Before finding an effective treatment Melanie Johns would wake up every morning with an unbearable scratching sensation. She was embarrassed to show her legs and angry that there was nothing she could do about it. It wasn’t until recently that biologic drugs came into the picture and turned her life around for the better. But it came at a cost.

Johns, 52, was diagnosed with psoriasis when she was 18 years old and suffers from the severe side effects of the disease. In order to keep her condition in check she is currently spending $40,000 on medication every year. And now as she is reaching retirement she is beginning to wonder how she is going to afford the cost of her treatments.

What is psoriasis?

Psoriasis is a serious problem that effects one million Canadians. The disease ranges from mild irritation whereby a rash covers three per cent of the body, to a more severe condition that covers 30 to 70 per cent of the body. This more severe irritation is the most popular form of the disease and is referred to as plaque psoriasis. It is a chronic autoimmune condition that appears on the body in patches of thick, red, scaly skin.

Plaque psoriasis is the most common form of the disease affecting close to 90,000 Canadians [Photo courtesy of Psoriasis-Netz]

Many people who suffer from plaque psoriasis struggle to find a medication that actually relieves their pain. For less severe conditions topical treatments such as creams and ointments work just fine, however, it’s those who suffer more chronically, like Johns, who have a harder time getting that momentary relief.

Viable options are available to people suffering from these severe side effects, however access to certain drugs has proven to be difficult for many Canadians. A lot people do not have access to the necessary benefit plans that would allow them to pay for these expensive treatments.

New drug developments

Over the past decade new medications have been researched and developed to help alleviate the symptoms of psoriasis. One of the newest treatments being Taltz (ixekizumab). Taltz is marketed by Eli Lilly and is a monthly injection that has a 90 per cent success rate amongst patients suffering from plaque psoriasis.

Taltz was approved by Health Canada last June and is an monoclonal antibody that reduces the effects of a chemical substance in the body that can cause the effects of psoriasis. Also, Taltz is considered a biologic drug and that is what is driving its cost up so high.

Biologic medication is manufactured in a living system such as a microorganism — or plant or animal cells. Biologic medications like Taltz are created as extremely targeted therapies that block specific interactions in the immune system, which regular drugs can’t do.The only disadvantage is the Price. Taltz costs an average patient $4,104 a month, that’s $49,248 a year.



The rising cost of psoriasis medications

Dr. Kim Papp, a dermatology researcher based out of Waterloo, says that it doesn’t look like these prices will be going down anytime soon.

“We will never have drugs that cost less,” he says. “We as consumers or your physicians as prescribers have demanded more safety information. And in response, the federal government has had to put on more and more layers in conducting these studies and all that does is increase the cost of development.”

Unless patients have a good benefit package through their work it is nearly impossible for the average Canadian to afford these medications — a key flaw in Canada’s health care system, patient advocates say. According to a 2015 study published in the Canadian Medical Association Journal (CMAJ), “Prescription drugs in Canada are currently funded by a fragmented patchwork of public and private drug plans that varies by province and leaves many Canadians with little or no drug coverage at all… one in ten Canadians report they cannot afford to take their medications as prescribed.”
However, Kathryn Andrews-Clay, Executive Director of the Canadian Skin Patient Alliance, says that the provincial government is moving in a direction that could help resolve the problem.


Before and after photo of biologic psoriasis treatment [Photo courtesy of Pima Dermatology 2015].

According to Andrews-Clay, a lot of biologics, like Taltz, are working to get on public formularies. Formularies are a list of medications approved by the government in which patients will receive some financial aid which will help them pay for expensive drugs.

“The problems with biologics is that each province decides which ones they will list on public formularies,” says Andrews-Clay. “Say you’re on [a drug] and you’re doing well and you’re happy with how your psoriasis is, we don’t want the government to come in and say ‘now you need to go onto inflectra because it’s cheaper for us,’ we want that decision to be made by the doctor and the patient,” she adds.

The future of biologics

It does look like biologics are going to be the future medication for patients suffering from severe psoriasis; and as of right now Papp says that they will continue to be one of the safer options for patients.

However, Andrews-Clay says, “Biologics, I would say, are the most potent of the drugs available. And they have only been around for about ten years. So, we don’t know yet what the effect will be on someone who has been on them for say 30 or 40 years.”

“I was in a focus group with some patients and one of them said, ‘even if you tell me that there is a chance of me getting cancer…I will take that risk because this works so well for me that I want to have a better quality of life now,’” she says.

As for the cost, it seems like the government of Ontario is working to implement biologic drugs into public formularies. Adalimumab, a biologic drug used to treat psoriasis patients, has recently been registered. While the registration of Adalimumab is a step in the right direction many problems still remain. This specific drug does not necessarily work on all patients. Therefore, until more biologics are introduced into provincial formularies  Andrews-Clay says that psoriasis sufferers will remain paying for their costly treatments.

Johns sees this as a lingering problem that she will have to face over the next few years. “I can retire in the next year or two but there is no plan that I can buy that will actually cover the costs of these treatments.”