North Okanagan patients could soon lose critical coverage for eye injections

A number of patients in the North Okanagan could soon lose coverage for the eye injection medication that prevents them from going blind, leaving them to choose between onerous travel to receive the injections elsewhere or exorbitant bills to have them done locally. Vernon physician Dr.

Hussein Hollands says that just two weeks from now, some of his elderly patients will be forced to choose a third option: going without the medication and suffering the consequences. Hollands, who specializes in medical retina ophthalmology, told The Morning Star that for months he’s been asking the Ministry of Health to accommodate his patients with extended coverage after he left a program he said was unfair to him.

Coverage for eye injection medicine is currently tied to this program for retinal specialists in B.C., such that leaving the program effectively means cancelling the coverage. Hollands wants this to be changed. He is concerned that a number of his patients will soon be without the injections that are critical to maintaining their vision, unless the province heeds the call he’s been making to adjust its coverage model.

The province is pinning the blame on Hollands for opting out of the program. But Hollands says the adjustment would be administratively straightforward and cost-neutral. He’s been asking the Ministry of Health for it since May and is unsure why he hasn’t been listened to.

“Every day, I’ve been talking to patients who I know, after treating them for years with their retinal disease, that they will permanently lose their vision without this treatment,” Hollands said. “They cannot pay for this, and they cannot travel outside of the community, at least some of them, to get that treatment.” Hollands explained that these medicines can cost up to $600 per eye, and some patients need to have them done every four to six weeks.

That works out to as much as $14,500 per year. He said he currently has 1,400 patients and roughly 20 per cent of them need the most expensive type of medicine. Hollands opted out of the Provincial Retinal Disease Treatment Program (PRDTP), which provides complete coverage for a number of drugs for treating retinal diseases when the drugs are prescribed and administered by retinal specialists such as him.

He did so because he said there were significant inequities in the program. Under the PRDTP, an alternate payment plan was put in place for retinal specialists which is separate from how doctors in B.C. normally get paid through fee-for-service. Hollands explained that he’s the only retinal specialist covering a large rural area, from Vernon to Salmon Arm to as far as Nakusp.

He runs a travelling clinic that meets patients where they’re at because many aren’t in suitable physical condition to travel to him. He’s been doing this for 14 years. It’s unsustainable, he said, so he chose to return to fee-for-service compensation which the vast majority of B.C. doctors use.

“You’ve got a group of 1,400 patients, some of whom are going to go blind, and have a doctor ready to treat them, and you’re deciding not to cover that for the reason of how the doctor gets paid,” Hollands said. “That’s not ethical, and it’s not right, and it’s not fair.” Hollands gave his notice of leaving the PRDTP almost six months ago.

As of Nov. 13, he will no longer be part of the program, and if nothing changes, that’s the date his patients will lose coverage. Health ministry responds It does not appear that the Ministry of Health intends to extend coverage to Hollands’ patients beyond Nov.

13 at this time. The ministry is “disappointed” in his decision to leave the program, a spokesperson for the ministry said in an email. “Because retinal specialists must participate in the program to access publicly funded drugs on behalf of their patients, Dr.

Hollands’ decision to leave the program means patients who continue to receive treatment from him will no longer have access to these drugs provided at no cost through the program,” the ministry said, adding it has worked with Hollands and the Association of British Columbia Retina Specialists to address patient access issues.

“It is unfortunate we have not been able to reach a resolution that is beneficial for all parties, most importantly patients,” the ministry said. The ministry and the Provincial Health Services Authority are trying to establish continuity of care for patients, and transfer of care where appropriate.

The ministry ultimately landed on the conclusion Hollands is fearing: “Patients can either receive drugs at no cost through another retinal specialist within the PRDTP or pay out-of-pocket costs if they continue to be treated by Dr. Hollands. “We recognize patients may need to travel outside of their home communities to access specialist care; medical travel and patient transportation supports are available through the ministry and Interior Health,” the ministry added.

Hollands said he reached out to Interior Health in the hopes that it could support him in pushing for extended coverage, but he said no such support has materialized, and the health authority referred The Morning Star back to the ministry on the matter. Hollands said because the solution wouldn’t cost the province additional funds whether he’s in the PRDTP or not, it’s a “no brainer” for the government and should be pursued.

He has a petition with more than 850 signatures from patients at his Vernon clinic, along with personalized letters that are being sent to the provincial government. MLA-elect pushing for more time Kevin Acton won the election to become MLA for Vernon-Lumby with the new BC Conservative government last week.

He told The Morning Star that, having not even been sworn in yet, he’s not in a proper position to directly respond to Hollands’ coverage issue. That said, Acton said he’s trying to buy some more time for the issue to be looked into before coverage is cut off. Hollands and Acton spoke directly about the matter.

“What I told him is that I would make some phone calls to try and get something put in place so that he could get an extension of the coverage until we get into government and get things figured out,” Acton said Friday morning. “Obviously we don’t want people in this region going without (coverage).” Acton said he’s interested to see how or whether the issue can be resolved, saying he’s learned it’s a “very complex” situation from talks with Interior Health.

Hollands has been fighting for a solution since May, when the province was being governed by the BC NDP. He said he was told the government was “working on a solution” repeatedly, but in late September was told that things were at a “standstill” due to the provincial snap election.

He hopes a solution will come to pass for the sake of his patients. “Patients are entitled to receive equal coverage for these sight-saving medications across the province, regardless of how their retinal specialist is compensated for care,” he said.