Grant: Project Grant

Biologic medicines, among the most expensive medications ever sold in Canada, require administration by intravenous (IV) infusion every 6-8 weeks. To encourage their use, pharmaceutical companies set up a network of private infusion outpatient clinics where drug costs are covered by private and provincial benefits plans, or out of pocket, effectively circumventing processes used by hospitals to determine whether a drug was sufficiently cost effective to warrant reimbursement or inclusion on formulary. There has been no in-depth exploration of the extent of private infusion care for patients prescribed high-cost biologic drugs in Canada. Canada spends more on biologic drugs than most other countries due to higher prices and lower uptake of cost-effective biosimilar drugs, and reliance on private infusion care may be a barrier to implementing more sustainable policies. Patient, clinician, and health system dependence on pharmaceutical industry-funded infusion services has significant health system and regulatory implications including access to and continuity of care, patients' out-of-pocket health spending, and decisions related to public reimbursement, pricing, and drug safety. Industry seeks to inform drug regulatory processes using proprietary data collected during patient encounters, but there is little public oversight of these data. Using in-depth, qualitative methods, including documents review and qualitative interviews, this multi-disciplinary research team will systematically map the entities providing private infusion care across Canada; explore the patient and clinician experience navigating the public health system and private infusion care; and analyze the ways industry data are informing decisions around drug reimbursement or pricing. The goal of the project is to provide actionable evidence to inform equitable and sustainable public pharmaceutical policy related to medicines access, safety, value for money, transparency, and public accountability.