Quinn Grundy, an Assistant Professor at the Lawrence Bloomberg Faculty of Nursing has been awarded a grant from the Canadian Institutes of Health Research to examine the use of private infusion clinics for high-cost biologic medicines to better understand their impact on the public health system in Canada, and patients themselves.
Compared to other high-income countries, Canada pays among the highest amounts per capita for biological medicines, a class of drugs that are manufactured in living cells, and due to their instability, are often administered intravenously. These drugs are some of the most expensive drugs to come to market and are prescribed to treat autoimmune conditions, are used as chemotherapy or oncology drugs, or to treat other rare diseases.
According to Grundy, when these drugs first came to market, to encourage their use, drug manufacturers set up exclusive networks of third-party, private infusion clinics and offered a range of patient supports to people prescribed their drug.
“In Canada, if you are prescribed these biological drugs, you will likely receive infusion care that is paid for by the manufacturing drug company,” says Grundy. “We want to understand the oversight around these private infusion clinics, who is funding them, the perspectives of referring and infusion clinic healthcare providers, and the experiences of patients receiving care.”
Today, biologics account for the largest, and growing, proportion of drug spending, threatening the sustainability of public drug plans. In recent years, ‘biosimilar’ alternatives to these drugs have become available, and many provinces are eager to switch to these cost-effective alternatives. However, access to infusion care is tied to the drug a patient is prescribed. Some of the key points that Grundy aims to address in her research are around the potential impacts of these clinics on continuity of care, privacy of data, and quality of care. These are questions she says, we need to be asking if these clinics have become the default option for people prescribed this class of drugs.
Grundy will be conducting an environmental scan to document the landscape of private infusion care delivery and oversight in Canada, in addition to recruiting individuals who work at these clinics, refer patients to infusion care, or are themselves recipients of private infusion care for interviews to better understand how care is coordinated and delivered.
As Canadians begin to think more seriously about pharmacare, Grundy notes that it is imperative we gain a better understanding of policies around medication access including in the case of these biological drugs, to ensure not only equitable access, but transparency and accountability on the part of all parties involved.
“When we study care, it is important to ground our understandings in the experiences of people who give and receive that care and make it visible,” says Grundy, “I think we have taken care for granted and it needs to be sustained and valued, and that includes ensuring it is delivered equitably.