Abortion pill’s high cost triggers petition

By Olivia Bowden

The abortion pill is now available in Ottawa, more than a year and a half after it was approved for sale by Health Canada.

But with the medication costing more than $425 in the city, Planned Parenthood Ottawa has launched a petition urging the province to provide universal coverage for the drug, officially called Mifegymiso.

The price tag and lack of available clinics and doctor’s offices that stock the drug make it largely unavailable to many women, said Catherine Macnab, executive director at Planned Parenthood Ottawa.

“The biggest barrier is the fact that so few people can afford it,” said Macnab.“Having it priced out of reach for most people is not making it a choice.”

The petition, on change.org, is directed towards Dr. Eric Hoskins, Ontario Minister of Health and Long-Term Care, and Suzanne McGurn, executive officer of Ontario Public Drug Plans. It will be sent to both when it attracts 1,000 signatures; as of March 14, there were 898.

In the petition letter, Planned Parenthood outlines the core issues that stem from the high cost of the medication. A drug that can be taken at home is discreet and saves the cost of driving to a clinic or hospital that provide surgical abortions. In many rural communities, surgical abortions aren’t available nearby.

Some women have to travel hundreds of kilometres to reach an abortion service provider, as it’s only available at about 16 per cent of hospitals in Canada.

Mifegymiso would save the travel step — if it was affordable, said Macnab. The drug is considered the gold standard in care and has been approved in most developed countries, including the U.S, when it became available in 2000.

After a series of delays, the medication was finally approved in July 2015 in Canada but only became available at the end of January this year.

The drug is a two-step process that involves taking two pills that are sold together in a combination pack.

The first, mifepristone, blocks progesterone causing the lining of the uterus to break down. The other, misoprostol, is taken 24 to 48 hours later and induces a miscarriage via contractions.

The distributor of the drug in Canada, Celopharma Ltd., proposed a list of conditions that Health Canada followed when it approved the drug in July 2015. This included women being unable to take Mifegymiso if they are more than 49 days pregnant and that doctors must distribute the drugs.

Currently, doctors and pharmacists must complete a six-hour long course before they are allowed to order the medication.

But with such a high price tag for a medication, opting for a surgical abortion that is covered by OHIP — even when incurring travel costs — ends up being a better option, said Macnab.

She said Planned Parenthood had anticipated the drug would cost between $200 and $300, making the current price tag much steeper than predicted.

Macnab said the petition is meant to raise awareness of the cost issue and press the Ontario government to take action to increase coverage for the medication.

Hoskins has not reacted to Planned Parenthood’s petition and his office did not respond to requests for an interview.

In Macnab’s letter to Hoskins, she stated that those with private insurance might be able to purchase the pill, and those with low income may be able to obtain the medication via the Ontario Drug Benefit, if it gets listed. But those with middle incomes will not be covered unless it is listed by OHIP.

She points out there is a precedent for universal OHIP coverage of essential drugs. For example, the Naloxone Pharmacy Program that treats patients for drug overdoses, including those involving fentanyl, covers the cost of the life-saving antidote.

“Something as critical as this is going to be kept out of reach for people,” she said. “The province needs to take the lead on this issue.”

The cost issue is also exacerbated by the fact that only three clinics in the country have so far requested a stock of the pill, said Macnab. Celopharma, the distributor of the drug in Canada, said it has only shipped the product to locations in British Columbia, Alberta and Ontario. They said overall it’s available at five abortion clinics and a few pharmacies in big cities.

The delays in making the medication available and the high cost are entirely unnecessary, said Dr. Anne Niec, president of the Federation of Medical Women of Canada.

“We’ve put in so many barriers that it’s making it very difficult for not only people to prescribe, but for people to obtain the medication,” she said. “It discriminates against women of low socio-economic status.”

The six-hour training course that doctors must complete poses another barrier to proper care, she said. For similar drugs like methotrexate, no such course needs to be completed.

Niec said the federation is pushing for the drug to be covered by OHIP, along with Action Canada For Sexual Health and Rights, located in Ottawa.

“It’s about equitable availability,” she said. “It’s available but you need to be on the inside to know how to get it.”

“At the end of the day it shows that we as a nation don’t support abortion. It’s legal, but it’s a mixed message.”