The government of British Columbia is currently evaluating whether to provide public funding for an expensive but potentially life-saving medication designed for patients with a genetic cholesterol disorder who cannot tolerate standard treatments.
High Cost, High Stakes for Patients with Genetic Condition
The drug in question, called Leqvio (inclisiran), comes with a significant price tag. The first year of treatment costs more than $9,000, with subsequent years priced at just over $6,000. This places it out of reach for many patients without coverage. The medication is intended for individuals with heterozygous familial hypercholesterolemia, an inherited condition that causes dangerously high levels of LDL, or "bad," cholesterol from birth, significantly increasing the risk of heart attacks and strokes.
For these patients, lifestyle changes and diet alone are insufficient to manage their condition. While statins—the most common cholesterol-lowering drugs—are effective for millions, a subset of patients experience severe side effects, including debilitating muscle pain, weakness, and in extreme cases, a complete muscle breakdown known as rhabdomyolysis, which can lead to kidney failure.
From Rejection to Re-Review: The Path to Potential Coverage
B.C. initially reviewed Leqvio for public funding in 2022 and decided against it, aligning with recommendations from the Canadian Drug Expert Committee and Canada’s Drug Agency (CDA) at the time. However, the landscape has shifted. In 2024, the CDA issued new recommendations, suggesting the drug be reimbursed for eligible patients under specific clinical and cost-effectiveness conditions.
In response to this updated guidance, B.C.'s Health Ministry has reopened its review. A spokesperson confirmed the province expects to make a coverage decision "in the near future." This potential policy change highlights the ongoing challenge of balancing cutting-edge medical treatments with sustainable pharmacare budgets.
The Science Behind Statin Side Effects and New Alternatives
The need for alternatives like Leqvio is underscored by recent research from the University of British Columbia. Scientists there, led by Dr. Filip Van Petegem, a professor in the UBC faculty of medicine, discovered the biological mechanism that causes statins to induce muscle fatigue and pain in some individuals. This breakthrough paves the way for the future development of new statin drugs without this side effect.
Dr. Van Petegem explained to Postmedia that Leqvio represents a different class of treatment. It is an RNA interference drug administered via subcutaneous injection by a healthcare provider. "Every drug, including Leqvio, comes with its own set of side-effects," he noted, "but if a patient is at risk for statin-induced myopathy or rhabdomyolysis... then drugs like Leqvio should be considered, particularly if the patient is clearly at risk for cardiovascular disease."
The decision facing B.C. pharmacare is not merely financial but deeply clinical. For a small group of patients with a severe genetic disorder for whom first-line therapy is not an option, access to Leqvio could be a critical step in preventing life-threatening cardiac events. The province's impending verdict will be closely watched by patients, clinicians, and advocates across the healthcare system.
