Rafaye, in the UK the cost of medication is covered by the NHS - regarding CML drugs. Imatinib 400mg is first line therapy and has been approved as such since 2003. Nilotinib and dasatinib have just been through the approval process for 1st line therapy. Unfortunately, dasatinib was not given approval because of cost. Nilotinib was approved because the manufacturer offered a discounted price to the UK health authority, through a patient access scheme. So nilobinib and standard dose imatinib are available as both 1st and 2nd line therapy. We are hoping that dasatinib will eventually be discounted by its manufacturer in a similar manner which will mean it would be available for 1st line (but not second line). Meanwhile, if patients need access to dasatinib (and some do) their doctor can apply for payment from a fund set up by the present government call the CDF or cancer drugs fund. But individual clinicians need to apply for this on behalf of there patients.
Most European countries have similar National Health systems, but differ from the UK as most are (I think) based on some kind of insurance payment.
Most have some kind of welfare back up should people not be able to pay for expensive treatments, but I am not sure of the individual systems.
Australia has a health system based on insurance and some element of 'co-pay'. But I am not sure of the details.
In the USA the situation is different to the UK as people must rely on health insurance plans via the workplace. There is I think also an element of co-pay.
If they do not have insurance through work, or they lose their job , then they are in a very very difficult situation.
Members of this forum who are based in the US can correct me on the details as I am not overly familiar with the details of the system.
In other regions of the world CML patients can apply to the Max Foundation for GIPAP (glivec international patient access programme) which assesses a persons income and if it falls below a certain level they might be eligible for donation of imatinib from the foundation.
Generic imatinib is available in India, but as you say, even that is beyond many people's ability to pay. Access to effective therapy remains distressingly unequal.
Best wishes,
Sandy
