ACCESS TO BIOLOGICS: Change usage code from Exceptional Access Program (EAP) to Limited Use (LU)
For the first time there are medications being designed specifically for lupus. These new medications are called Biologics. Biologics are advanced medications designed to target specific components of the immune system, unlike older, non-specific drugs such as steroids and immunosuppressants. They are crucial because they target specific pathways in the immune system to reduce inflammation and prevent joint and tissue damage, thus allowing faster and more effective tapering of corticosteroids and improving overall physical function and quality of life.
Currently, these medications are only available to lupus patients under the Exceptional Access Program (EAP). This program requires rheumatologists to undergo an extensive time-consuming, and detailed application process to gain approval. The EAP approval process takes 3-5 weeks, imposing an unnecessary administrative burden on already resource-constrained rheumatologists and significantly delaying access for lupus patients in need. In addition, the EAP process only grants approval for 12 months making reapplication necessary. This creates additional administrative burden and interruptions in treatment.In the summer of 2024, Lupus Ontario created a Biologics Petition advocating for a change in the usage code of lupus biologics from EAP to Limited Use (LU). The petition was to support and endorse the listing of all current and new lupus-specific biologics approved by the Canada Drug Agency on the Ontario Drug Formulary under the Limited Use code. Signatures have been collected and will be presented at the Ontario Legislature in the Spring of 2025.
ACCESS TO VACCINES: COST COVERAGE BY OHIP
Many lupus patients are moderately to severely immunocompromised due to the disease itself and immunosuppressive treatments that are often required to control lupus symptoms. This puts lupus patients at high risk for severe illness and complications if they contract infections. In fact, the Canadian Immunization Guide (2024) notes that “infections are among the most common causes of morbidity, hospitalization and death in individuals with an autoimmune condition.”
While Ontario’s vaccine prevention programs are funded for certain high-risk populations, lupus patients are not eligible for some of these vaccines unless they meet other eligibility criteria such as age or accommodation. This leaves lupus patients who cannot afford to pay for the vaccines, or who do not have private insurance, vulnerable to illness, complications, and hospitalizations in addition to associated healthcare costs.
In 2025, an advocacy initiative commenced to bring this deficiency to the attention of the appropriate health authorities so that vaccines such as RSV, HPV, Shingles, Pneumonia and High-Dose Flu will be covered under the Ontario Health program.
See our Call for Action urging all Ontario political parties to commit to expanding vaccine access in the upcoming provincial election.