On a rain-soaked Tuesday morning in Port Alberni, Karen Miller carefully navigates the three steps leading to her front porch—a mundane task that has become increasingly treacherous since her multiple sclerosis diagnosis seven years ago. At 51, Miller fights not just the degenerative neurological condition attacking her central nervous system, but also an exhausting bureaucratic battle with British Columbia’s healthcare system.
“Some mornings I can barely feel my feet,” Miller tells me as we settle at her kitchen table. A stack of medical documents sits between us, chronicling her journey with MS and her ongoing struggle to access Ocrevus (ocrelizumab), a medication that could significantly slow her disease progression. “My neurologist says this is my best option, but the province won’t cover it unless I deteriorate further. They’re essentially asking me to get worse before they’ll help me get better.”
Multiple sclerosis affects nearly 90,000 Canadians, with British Columbia having one of the highest rates in the country according to the MS Society of Canada. The disease causes the body’s immune system to attack myelin, the protective covering around nerve fibers, leading to communication problems between the brain and the rest of the body. Symptoms range from numbness and weakness to severe mobility issues and cognitive impairment.
Ocrevus, approved by Health Canada in 2017, has shown remarkable efficacy in clinical trials for both relapsing-remitting and primary progressive forms of MS. The twice-yearly infusion works by targeting and depleting a specific type of immune cell (CD20-positive B cells) that contributes to nerve damage in MS. For many patients, it has meant fewer relapses, slowed progression, and improved quality of life.
However, the medication costs approximately $34,000 annually—a prohibitive expense for most patients without coverage. While several provinces including Ontario, Alberta, and Quebec have expanded their coverage criteria for Ocrevus, British Columbia maintains stricter eligibility requirements.
“In B.C., you need to have failed on two other MS medications before they’ll consider covering Ocrevus,” explains Dr. Anthony Traboulsee, Director of the MS Clinic at the University of British Columbia Hospital. “The problem with this approach is that we’re allowing irreversible damage to occur while cycling through medications we already suspect won’t be as effective for certain patients.”
For Miller, this creates an agonizing situation. Previous MS medications caused severe side effects, including liver problems and depression. Yet these adverse reactions don’t constitute “failure” under B.C.’s current criteria—patients must show continued disease progression while on these medications.
“It’s like they’re asking me to get sicker just to prove I need better medication,” Miller says. “By then, the damage is already done.”
The BC Ministry of Health, through PharmaCare, determines drug coverage based on recommendations from the Canadian Agency for Drugs and Technologies in Health (CADTH) and the pan-Canadian Pharmaceutical Alliance (pCPA). These bodies evaluate medications based on clinical evidence and cost-effectiveness.
When I reached out to the Ministry of Health regarding Ocrevus coverage, a spokesperson provided this statement: “Coverage decisions balance clinical evidence, expert input, and fiscal responsibility. The Ministry regularly reviews criteria as new evidence emerges.”
But for patient advocates, this approach ignores the time-sensitive nature of MS treatment. Tania Vrionis, President of the MS Society of Canada’s BC & Yukon Division, emphasizes that early intervention is crucial for long-term outcomes.
“Every day matters with MS,” Vrionis says during our phone conversation. “When we delay access to effective treatments, we’re allowing permanent damage to accumulate. The costs—both human and economic—of allowing disability to progress far outweigh the medication expenses.”
This economic argument resonates with Dr. Jonathan Fowler, a health economist at Simon Fraser University who studies pharmaceutical policy. “When we only consider the upfront costs of medications without accounting for reduced hospitalizations, preserved workforce participation, and decreased need for disability supports, we’re not seeing the complete picture,” he explains.
For Miller, the financial calculations are immediate and dire. Unable to continue working as a dental hygienist due to worsening symptoms, she’s now considering selling her modest home to pay for Ocrevus out-of-pocket.
“I’ve worked and paid taxes my entire life,” Miller says, her voice tightening. “I’ve never asked the system for much. Now that I need help, I feel abandoned.”
Miller isn’t fighting this battle alone. Through social media, she connected with dozens of other British Columbians in similar situations. Together, they’ve formed MS Action BC, a grassroots advocacy group pushing for policy change. Their petition for expanded Ocrevus coverage has gathered over 7,000 signatures.
One of those advocates is Michael Chen, a 38-year-old software developer from Richmond who received Ocrevus through his private insurance before it expired when he could no longer work full-time.
“The difference was night and day,” Chen tells me during our video call. “On Ocrevus, I had energy again. The brain fog lifted. I felt like myself for the first time in years.” Since losing coverage six months ago, he’s experienced three relapses and now uses a cane.
For residents in other provinces, the situation can be markedly different. Quebec expanded Ocrevus coverage in 2021 to include patients with active relapsing-remitting MS who haven’t tried other medications first. Ontario followed suit in 2022.
As I prepare to leave Miller’s home, she shows me a calendar where she’s marked potential infusion dates—if her coverage appeal succeeds. Each date is surrounded by hopeful question marks.
“MS teaches you patience,” she says with a faint smile. “But waiting for bureaucracy moves even slower than my disease.”
The next day, I visit the UBC MS Clinic where Dr. Traboulsee and his team treat over 7,000 MS patients. In the waiting room, I notice the diverse faces of MS—young professionals with barely perceptible symptoms sitting alongside older patients in wheelchairs.
“The frustrating part for clinicians is knowing which medication would likely work best for each individual patient, but having our hands tied by coverage criteria that doesn’t align with current medical evidence,” Dr. Traboulsee says.
As British Columbia reviews its pharmaceutical policies, patients like Miller continue their dual fight—against MS and for access to medications that could change their disease trajectory. For them, each day without optimal treatment represents irreversible losses.
“I’m not asking for special treatment,” Miller says as I leave. “I’m asking for the same opportunity that MS patients in other provinces have—the chance to try the medication my doctor believes will help me most, before more damage is done.”
