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Posts Tagged "force"

27May

B.C. becomes first province to force change to biosimilar drugs

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Biosimilars are manufactured after the 20-year patent period expires on biologics.


Francis Georgian / PNG

Starting today, over 20,000 B.C. patients with cancer or chronic diseases like arthritis, colitis and diabetes will have six months to transition to drugs that are similar to those they’re taking as the province becomes the first in Canada to stop covering some expensive, formerly patented drugs.

Health Minister Adrian Dix promised that no harm will come from the change that will initially save the government more than $96 million in its prescription drug program (PharmaCare).

The savings will be plowed back into the drug budget to allow for funding of drugs that have not yet been covered such as Jardiance, a medicine known as an SGLT2 inhibitor for diabetes. Another drug for psoriatic arthritis called Taltz will also be immediately available.

Since some of the soon to be phased-out government-funded drugs like Remicade have to be given at infusion clinics, Dix said there may be some inconveniences as patients find new locations. But patients will work with their doctors to make the switch to “biosimilar” drugs, which are the just-as-safe and effective copycat versions of brand name bioengineered drugs called biologics.

Biosimilars are manufactured after the 20-year patent period expires on biologics. They cost anywhere from 25 to 50 per cent less than the original biologic drugs which are said to be the single biggest expense for public drug plans like PharmaCare.

European countries have led the way in transitioning patients to biosimilar drugs, but Canada has lagged far behind.

In 2018, B.C. spent $125 million on Lantus, Enbrel and Remicade, three biologic drugs that treat chronic conditions such as diabetes, arthritis and Crohn’s disease.

“Biosimilars (like infliximab) are a necessary step to ensure PharmaCare provides existing coverage for more people and funds new drugs well into the future,” Dix said.

PharmaCare coverage for certain biologics will end Nov. 25. After that time, PharmaCare will provide coverage for the original drugs only in exceptional cases and they will be decided upon on a case-by-case basis.

B.C. has spent the last nine years studying the matter before making the decision. It consulted with physician and patient groups like the B.C. Society of Rheumatologists, endocrinologists, Doctors of B.C., Arthritis Consumer Experts, Canadian Arthritis Society, B.C. Pharmacy Association, Neighbourhood Pharmacy Association, regional health authorities, Health Canada, and the Patented Prices Medicine Review Board.

About 2,700 Crohn’s and ulcerative colitis patients will also be affected by the transitioning policy, but information for gastroenterology patients will be available in a month or two.

Rheumatologist Dr. John Esdaile said B.C. becomes an overnight Canadian leader with the cost-saving policy change.

“It’s a great day for B.C., for patients, for PharmaCare and for health care in general,” he said, noting that many European countries have had such a policy for 10 years with no evidence of detriment to patients. “I don’t know of any bad news,” said Esdaile, scientific director of Arthritis Research Canada, which has been “badgering” the province to enact such a change.

“For years, B.C has been spending money it doesn’t need to spend on expensive biologics instead of using biosimilars which I call biogenerics since they work just as well,” Esdaile said.

Cheryl Koehn, president of Arthritis Consumer Experts, said society will benefit from the new policy because coverage for other conditions and drugs will expand.

MORE TO COME.

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3Apr

National chronic pain task force a first step: federal health minister

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‘People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,’ says Andrew Koster.


‘People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,’ says Andrew Koster.


CHAD HIPOLITO / CANADIAN PRESS files

The federal health minister is forming a national task force to provide input on how to better prevent, treat and manage chronic pain, which affects one in five Canadians and is often addressed with opioids.

Ginette Petitpas Taylor said in an interview Wednesday the task force will provide information on barriers that may prevent people suffering with persistent pain from receiving the treatment they need.

“This is the first step in addressing the issue of chronic pain in this country,” she said, adding the eight members will consult with governments and advocacy groups around the country and provide an initial report in June, followed by two more over the next couple of years.

Petitpas Taylor made the announcement in Toronto at the 40th annual scientific meeting of the Canadian Pain Society, which has long called for a national pain strategy, especially as the opioid crisis has exacerbated the stigma around prescribing and use of the pain killers.

She said she committed to exploring the creation of a national pain task force after a discussion with patients, clinicians and researchers at a symposium in Toronto last year, when she heard people living with pain often feel their condition is misunderstood and services are inconsistent.

“We have to recognize that Canada’s a big country and we certainly know there’s inconsistent services in provinces and territories so I have to really have a good understanding of what’s available and what’s happening out there,” Petitpas Taylor said.


Ginette Petitpas Taylor, Minister of Health, stands during Question Period in the House of Commons on Parliament Hill in Ottawa on Thursday, Sept. 21, 2017.

Sean Kilpatrick /

The Canadian Press

Advocates for pain patients presented the former Conservative government with a plan in 2012, but Petitpas Taylor said it’s too early to say whether such a plan will be introduced.

Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, said he’s concerned the task force’s work will go nowhere if there’s a change in government in October.

“I’m looking for signs from the government that they’re taking this seriously and it’s not just something to state during an election campaign,” he said. “There has to be definite action.”

Koster, who will have surgery on his left knee next month following an operation on the other one last year, said he can no longer afford to pay $100 a week for acupuncture to deal with daily pain after he voluntarily reduced his opioids over concerns about any long-term consequences.

“People with chronic pain are often underemployed or unemployed because they simply cannot work and not all of us have extended health benefits and even health benefits run out,” he said from Victoria.

He said it’s crucial for the task force to identify non-drug costs for patients and provinces for services such as physiotherapy, occupational therapy and acupuncture as part of any strategy it may come up with in its final report.

Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, pictured at his home in Victoria in 2018.


Andrew Koster, who suffers from debilitating lower back and knee pain from a type of arthritis called ankylosing spondylitis, pictured at his home in Victoria in 2018.

CHAD HIPOLITO /

CANADIAN PRESS files

Serena Patterson, a 60-year-old psychologist in Comox, has lived with pain associated with fibromyalgia for over half her life and also developed migraines that prevented her from continuing her teaching job at a college.

She said a three-year task force seems excessive, especially because advocacy groups have enough information on health-care gaps and patients wait too long to see specialists.

“I think we know that people are dying in an opioid epidemic and chronic pain patients are high on that list,” Patterson said.

“I would hope that this three years would be building, not more research. What needs to be built is a network of multidisciplinary team programs that are accessible, that are in rural areas as well as urban areas, that provide not only medical support but psychological as well as social support to help people be full participants in their life and in their community.”

Dr. Norman Buckley, scientific director of the Michael G. DeGroote Institute for Pain Research and Care at McMaster University in Hamilton, said hundreds of organizations, patients, clinicians and researchers came together in providing the federal government with the strategy in 2012. There was no action at the time but he said the opioid epidemic has now made that unavoidable.

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20Feb

Task force set up to tackle sexual harassment at UBC medical school

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UBC medical students are being sexually harassed more often than students in other Canadian medical schools, according to a new report.

An internal memo written by Dr. Andrea Townson, acting co-head of the UBC department of medicine, and sent to medical faculty at the University of British Columbia, refers to the “deeply concerning” results from a 2018 questionnaire of students who graduated from the 17 medical schools across Canada. Sexual remarks, uninvited touching and sexual assault are examples of harassment.

• Twelve per cent of students at UBC reported unwanted sexual advances and touching by faculty, fellow students, health professionals or patients, compared to a national average of 6.5 per cent.

• Thirty-three per cent of students at UBC said they were subjected to offensive sexist remarks, compared to the national average of 25 per cent.

• A third of UBC medical students also said they were subjected to racially offensive remarks, compared to the Canadian average of 12 per cent.

“We aren’t unique or isolated with these concerns but we are obviously not happy to see these high reported rates so it’s launched a number of different initiatives,” said Dr. Deborah Money, executive vice dean of the UBC medical school.

UBC results from the annual report have been “steady” over the past number of years, according to Money.

Money is chairing a dean’s task force meant to find ways to change the culture and environment at the medical school and to prevent mistreatment and harassment at the more than 80 training sites where UBC medical students learn, such as hospitals and clinics.

“Part of our work has to focus on learning from others, so we know what best practices look like.”

Sixty per cent of UBC medical graduates said they had been publicly humiliated. This may include being asked a question by a professor in a group setting, not knowing the answer and feeling shame about it because of, for example, how the instructor reacted.

This raises the question of whether students are becoming more sensitive to these kinds of learning tools.

“That’s a tough question. It’s an old style of teaching and how it’s done or how it’s perceived may be different in each scenario. We have actually made a video that tries to distinguish between being challenged academically and being bullied or called out so much that people feel humiliated,” she said.

Money said staff have collected data on the reported incidents of public humiliation, racially or sexually offensive remarks and unwanted sexual advances experienced by students.

Townson told clinical faculty members in the memo obtained by Postmedia that if they are concerned they’ve made a comment that might have been misinterpreted and want “a safe place to debrief” they should come and speak to her.

She said in the memo that “addressing student mistreatment” is a priority and students need a clear mechanism for reporting concerns. UBC has several satellite sites — Vancouver, Victoria, Kelowna and Prince George — where undergraduate students learn and Townson said in her memo that the disturbing reports are “not isolated to a single site or a single rotation.”

Money said there are about 700 professors in the medical school and about 7,000 clinical instructors. When students complain about a particular instructor or fellow student, an investigation is launched to determine whether coaching or discipline is required. Money said she couldn’t say how often that occurs but said expulsion is “rare and extreme.”

The survey of medical school graduates in Canada covers a broad range of topics about the quality of education and student experience and has been conducted annually by the Association of Faculties of Medicine of Canada since 2015.

UBC is the fifth largest medical school in North America with 288 students admitted each year, and 4,500 students doing residencies and other postgraduate work.

At the same time as UBC is grappling with the mistreatment issue, the Lancet has published the results of an alarming survey showing that sexual harassment — by patients, teachers and peers of medical students — is common in Canada.

The study by researchers in Ontario and Alberta shows that despite policies and complaint mechanisms intended to promote respectful conduct and to prevent harassment, students are subjected to everything from sexist remarks to rape. A total of 807 incidents were reported by 188 respondents to the 2016 anonymous survey. The harassment occurred in clinics, medical schools and social settings; patients requested medical students touch their sexual organs and they groped doctors. One student said she was raped by a fellow student. Faculty members were implicated in about 20 per cent of the incidents that were predominately experienced by female students. Men were the most frequent perpetrators.

The authors say that faculty, peers and victims come to almost normalize sexual harassment. Students try their best to ignore it while at the same time finding it “confusing, upsetting and embarrassing.”

Many don’t report it because staying silent is seen as “less risky than confrontation or official reporting.”

Dr. Susan Phillips, a professor at Queen’s University and co-author of the Lancet study, said it is clear that women who are practising doctors or studying to become doctors are not immune to harassment and sexual assault.

“This is a societal problem. And we have to find ways to decrease the incidence,” said Phillips, who several years ago published a study in the New England Journal of Medicine showing that 78 per cent of female doctors had been harassed by inappropriate comments or conduct by patients.

“Medical schools can’t fix societal problems but they can do more to legitimize student concerns. That means if they hear about a patient or faculty member making inappropriate comments, they don’t let it go. There has to be zero tolerance and in the case of faculty members, it has to be enforced.”

One limitation of the Lancet study is that few medical students completed the survey. There are about 11,600 medical students across Canada and just under 300 completed the consent form to submit answers to the anonymous survey.

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7Jan

B.C. nurses negotiate pricey premium designed to force additional hiring

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A tentative contract negotiated by the B.C. Nurses’ Union for over 50,000 nurses is rich with bonuses that could far exceed the contract’s $3.99 billion in base costs paid by taxpayer-funded hospitals and other health facilities.

Details of the tentative agreement obtained by Postmedia show significant gains made by the BCNU. The deadline for ratification of the 2019–2022 contract by registered, psychiatric and licensed practical nurses is Jan. 21.

While the base wages stick to the government-framework of two per cent wage increases each year for public sector workers, the new contract compels health authorities to beef up staffing by filling hundreds of nursing positions that have been left vacant.

On average, nurses make about $45 an hour, but there are wide variations depending on experience and training.

If heath authorities do not hire more staff, nurses who are shouldering the burden of working in short-staffed units will be entitled to premiums ranging from $3 to $5 an hour. The premiums could cost taxpayers as much as $100 million a year, according to the union.

The amount is not included in the costs of the contract. It is considered an “unfunded liability” to health employers, so costs would come out of hospital and other budgets allocated by the provincial government.

The “working short premium” as it is called, will kick in on April 1, 2020 and is meant to force health authorities to get their staffing up to “safe patient care” levels and convert many of the 6,000 casual nurses into permanent positions, according to BCNU CEO Umar Sheikh.

“We think we are four million hours short of the proper level of patient care across the province. Health employers will now be the masters of their own fate,” Sheikh said.

While some nurses prefer to have casual positions for their flexibility, Sheikh said 13 per cent of the workforce are casuals, a proportion he maintains is far too high.

Nearly $200 million was paid in overtime to nurses last year and that, according to Sheikh, is a reflection of staffing shortfalls.

HealthMatch B.C., the government-funded agency that recruits health professionals from around the world, lists about 250 nursing vacancies in B.C. this week but that figure does not reflect the entire complement of vacancies since not all positions are posted. HealthMatch said it recruited 79 nurses from outside B.C. last year.

Sheikh acknowledged it may be difficult to find and hire enough nurses. But he said an assessment process will take place in the next year to help determine optimum staffing levels in various settings, based on patient needs. That means that staffing should be higher on units where patient illnesses are more severe.

Management in hospitals and other facilities should be keen to fill vacancies sooner than later if they want to avoid the “unsustainable” hit their budgets could take because of the working short premiums.

Under the tentative agreement, nurses will also be paid for every minute they work. Since nurses say they often do administrative work after their shift ends, a paid end-of-shift bonus will stop the “normalization” of unpaid work. For the first 15 minutes of such work (usually done as nurses are handing off patients to the next shift), nurses will be paid at their straight time rate of pay. When they work more than 15 minutes, they will be paid at an overtime rate.

Michael McMillan, president-CEO of the Health Employers Association of B.C., which negotiated the contract with the BCNU, could not be reached for comment. But Roy Thorpe-Dorward, a spokesman for the association, said no one there would comment until the contract is ratified.

Sheikh said there was more trust and goodwill in this round of  bargaining.

“I wouldn’t call this a scare tactic at all, I would say it’s more of a leap of faith,” he said, referring to the premiums which he said McMillan and health employers agreed to “because they are the right thing to do.”

“I applaud their courage.”

While the new contract mostly rewards those in the nursing profession, there is one nurses’ job benefit that may not be as lucrative in the future — massage therapy.

According to BCNU figures, massage therapy costs have jumped by over 900 per cent in the past 10 years. Nurses and their family members are entitled to unlimited massages and the benefit now accounts for 1.2 per cent of all payroll costs.

Sheikh said the annual cost of taxpayer-funded massages increased from $3 million to $31 million in the past decade. In the past three rounds of bargaining, the government and health employers have raised the issue of skyrocketing massage therapy costs and now the union has agreed to consider a cap or some other formula to bring such costs down.

Nurses will be consulted over the next year on possible changes to their extended health benefit plans. Under one option, they would have a flex benefit plan that would limit how much nurses and their family members spend on massage services while using cost savings there to improve vision, dental and drug benefits.

While nursing is known to be physically and emotionally draining, it is not clear why health employers and the government, many years ago, agreed to fund unlimited massages for nurses’ family members as well.

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