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Strengthening Medicare: A Framework to Modernize and Improve Medicare

Life Saving and Life Improving Drugs

Some examples of life-saving and life-improving breakthrough drugs that are often not available in government-run drug plans, but that are generally covered by private drug plans in the United States:

  • Cancer: Gleevec, the breakthrough treatment that prevents complications and death from some forms of leukemia, is not covered in New Zealand and is covered in England only after patients reach the advanced stage of the disease. Targretin (for certain lymphomas), Interleukin-2 (for kidney cancer), and Rituxan (for lymphomas) are not covered at all or covered only with significant patient restrictions in Canadian provinces like Ontario.
  • Alzheimer's Disease: Aricept, which improves brain function in many patients with mild to moderate dementia, is not covered in Quebec and is restricted in Ontario.
  • Arthritis: Enbrel, which enables many patients with rheumatoid arthritis to return to a normal life, is not available in Japan and not covered in Ontario or New Zealand. Celebrex and Vioxx, which have fewer side effects in many seniors than other pain relievers for arthritis, are restricted or not available in Australia, New Zealand, and many Canadian provinces.
  • Asthma: Singulair, a new treatment for asthma that does not have the side effects of inhaled corticosteroids, is not covered for adults and seniors in Australia, Belgium, Finland, and many Canadian provinces.
  • Depression: The first "SSRI" drug (a drug class that includes such widely used drugs as Prozac, Zoloft, Paxil) was not approved for coverage in Japan until 1999 - twelve years after such drugs were first covered in the US. In Canada, Wellbutrin is only covered for patients who are "unresponsive" to other treatments, and even then only through a special government program.
  • Diabetes: Avandia, a new oral drug that helps many diabetic patients avoid insulin injections, is not covered in Ontario or New Zealand.
  • Enlarged prostate: Proscar, which prevents the common complications of prostate enlargement in older men, is not covered in Ontario.
  • Gastrointestinal (stomach) symptoms and ulcers: Coverage of Prilosec, the #1 prescription drug in the United States, is limited to special conditions and time limits in Canada, and prior approval is required.
  • High blood pressure: Cozaar, Hyzaar,Univasc, Sular, Diovan, and other new drug treatments are not covered or covered on a restricted basis (for example, only in patients who have "proven" to government standards that they cannot tolerate other treatments) in Canada.
  • High cholesterol: Lipitor, Mevacor, and Pravachol are not on the "formulary" (covered drug list) or are covered on a very restricted basis in Australia or New Zealand.
  • Infant respiratory distress: Curosurf was first covered in the US in 1999, and is still not approved for use by the Canadian government.
  • Insomnia: Sonata, a drug that does not have the side effects of benzodiazepines like Valium, was first covered in the US in 1999 and is still not approved for use by the Canadian government.
  • Osteoporosis and hip fractures: New "bisphosponate" drugs like Fosamax strengthen bones and prevent hip and back fractures in older women without the often serious complications of hormone therapy. But in many Canadian provinces, Australia, Italy, France, Belgium, and other countries, Fosamax is only covered in very severe cases of osteoporosis, or only after a patient has had a bone fracture that the drug is designed to prevent.

The Appendix of the HHS Report, available at, includes many more examples of coverage restrictions and prohibitions in government-controlled prescription drug plans.

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