Monday, 16 January 2017

NB, NS and Newfoundland & Labrador Sign Agreements

Before the holidays, we shared a blog titled “Federal andprovincial governments clash about healthcare funding.” Since then, certain parties have made significant moves which could ultimately affect all Canadians.

Since our original post, three of the four Atlantic provinces have signed separate, bilateral healthcare agreements with the federal government.

New Brunswick was the first province to move forward with its own healthcare deal on December 22, 2016. This agreement gives the province 230 million dollars in funding over 10 years for healthcare and for programs for seniors.

Shortly after, Nova Scotia and Newfoundland and Labrador followed suit and agreed to their own unique healthcare deals.

The Nova Scotia government noted that they will receive approximately $287 million in new funding.  When asked about the agreement, Nova Scotia Finance Minister Randy Delorey said, “We were up in Ottawa, we did say we wanted to continue the conversations with the federal government; they reached out to have conversations and that’s our responsibility to the people of Nova Scotia.”
As for Newfoundland and Labrador, they agreed to a total of $160 million in new funding over the next 10 years.

Even though these agreements are already in place, all three include a fairly important clause which allows the three provinces to change their specific agreements if another province is able to secure a better deal from the federal government. Essentially, New Brunswick, Nova Scotia and Newfoundland and Labrador are ’hedging their bets’ so that if anyone else is able to negotiate a better agreement, they will be able to secure equal funding.

After hearing about these individual agreements, Quebec Health Minister Gaetan Barrette and Ontario Finance Minister Charles Sousa Minister both voiced their displeasure. On December 22, Minister Barrette tweeted that, "NB chooses to accept reduction of fed funding from 23,3% to 20% but also rely on other provinces to fight for a better offer. #cdnpoli". Minister Sousa added that it is "inappropriate for the federal government to be rushing before Christmas to cut 'side deals' with some provinces, rather than trying to seriously negotiate a national deal that's in all Canadian's best interests." 

So what does this all mean?

With three fewer provinces working towards a new agreement, some commentators believe that it will be harder for other provincial governments to continue negotiating a better offer than what was on the table before. With that being said, there are still a number of provinces which continue to demand an increase in funding.

“We remain optimistic that both the provincial and federal governments can come to an agreement that will improve patient care across Canada.” said Jackie Manthorne, President & CEO of the Canadian Cancer Survivor Network. “Our hope is that all provinces that remain without a new agreement can work together to secure the best possible deal for all Canadian patients.”



Thursday, 22 December 2016

Federal and provincial governments clash about health care funding

Federal-provincial relations have been put to the test recently as the two levels of government try to reach a new accord on health care funding in Canada. As recently as Monday, December 19, 2016, the two groups met in Ottawa to discuss a possible deal and hopefully come to an agreement; however this was not the case.

(Adrian Wyld/Canadian Press)
News broke late Monday that the provinces had rejected the most recent government offer for a variety of reasons, but mainly because “it would ultimately reduce the federal contribution to overall health spending.” With different obstacles on the horizon, it was unfortunate that the two groups could not come to an agreement and it will be interesting to see what happens in the near future.

It should also be noted that the federal government and the provinces have very different mandates. Provinces are looking to secure as much funding as possible, and the federal government is looking to stretch each dollar in order to help all Canadians. One side is trying to gain as much funding as possible to improve the overall quality of health care for their residents, while the other side only has a certain amount of money that they must spread throughout a variety of different branches of government. Clearly negotiations are required.

However, certain industry leaders were not thrilled at the way things were handled. Canadian Medical Association president Granger Avery was quoted saying, “The Groundhog Day-type discussions where political leaders bat around percentages and figures at meetings in hotels have to stop. Our system needs better and most important, our citizens deserve better.”

But it’s not all bad.

As we mentioned, something of this magnitude will certainly require intense negotiations. To think that a 10-year plan involving billions of dollars could be agreed to in the first meeting between the groups may have been overly optimistic. The big positive that we can focus on from this meeting is that the two sides are willing to engage in an open dialogue, and we hope that this will lead to the best possible deal for patients across Canada. “If not,” said Jackie Manthorne, CCSN president & CEO, “patient care in Canada will suffer.”

As patients, survivors and caregivers, we ask that both groups remember where their focus should be, and that patients deserve a better standard of health care. We understand that coming to an agreement may not be easy, but we trust that both the federal and provincial governments will come to an agreement that will positively effect change throughout our health care system.


Be sure to stay tuned to our blog as we follow these negotiations in the New Year! 

Thursday, 15 December 2016

Federal Government Bans Asbestos Use by 2018

On Thursday, December 15th, the Canadian Government made a major announcement stating that they will be moving forward with a “whole-of-government approach to fulfill its commitment to ban asbestos and asbestos-containing products by 2018.”

The Honourable Jane Philpott, Minister of Health commented on the decision stating that “Across Canada and the world, asbestos-related cancers continue to hurt Canadian families and pose a significant burden for our health care systems. Our government is taking action to protect Canadians from substances such as asbestos that can be harmful to their health and safety.”

Canadian Cancer Survivor Network President & CEO Jackie Manthorne “Commends the federal government for moving forward with this initiative. With direct evidence proving that asbestos can cause both mesothelioma and lung cancer, we support the decision that works towards removing this material from Canadian buildings and homes. We also encourage the Federal government to continue to focus on providing Canadians with safe and healthy environments.”

 Below are some quick facts in regards to the announcement:
  • Asbestos was declared a human carcinogen by the World Health Organization's International Agency for Research on Cancer in 1987.
  • At the height of its use, asbestos was found in more than 3,000 applications worldwide; however, production and use have declined since the 1970s.
  •  Effective April 1, 2016, the Government of Canada introduced a ban on the use of asbestos-containing materials in all new construction and renovation projects under the purview of Public Services and Procurement Canada (PSPC).
  • PSPC has published a National Asbestos Inventory of federal buildings containing asbestos that it owns or leases.
  • There are no significant health risks if materials containing asbestos in homes are tightly bound and left undisturbed.
  • The government participates in the Rotterdam Convention, whose objective is to protect human health and the environment by promoting informed decisions about the import and management of certain hazardous chemicals.

If you would like to read the full press release, please click here.

If you are interested in learning more about asbestos, mesothelioma and lung cancer, please click here.

For additional information, please contact:

Jackie Manthorne
President & CEO
Canadian Cancer Survivor Network
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2X 2B5
613-898-1871



Tuesday, 6 September 2016

Four things you should know about the pending Charter challenge against Medicare

By Colleen Flood and Kathleen O’Grady, EvidenceNetwork.ca

A version of this commentary appeared in the Globe and Mail, the Medical Post and the Windsor Star

A long-running dispute between Dr. Brian Day, the co-owner of Cambie Surgeries Corporation and the British Columbia government may finally be resolved in the BC Supreme Court next year — and the ruling could transform the Canadian health system from coast to coast.

The case emerged in response to an audit of Cambie Surgeries, a private for-profit corporation by the BC Medical Services Commission.  The audit found from a sample of Cambie’s billing that it (and another private clinic) had charged patients hundreds of thousands of dollars more for health services covered by Medicare than is permitted by law.  Dr. Day and Cambie Surgeries claim that the law preventing a doctor charging patients more is unconstitutional.

Dr. Day’s challenge builds on the legacy of a 2005 decision by the Supreme Court of Canada overturning a Quebec ban on private health insurance for medically necessary care.  But this case goes much further, not only challenging the ban on private health insurance to cover medically necessary care, but also the limits on extra-billing and the prohibition against doctors working for both the public and private health systems at the same time.

A trial date was set to begin in 2012, but was adjourned until March 2015 so that the parties could resolve their dispute out of court and reach a settlement.  It now appears such a resolution has not been reached and the court proceedings resume in June 2016.

Here’s why this case matters:

1. Legal precedent: Whatever way the case is decided at trial, it is likely to be appealed and eventually reviewed by the Supreme Court.  A decision from this level will mean all provincial and territorial governments will have to revisit equivalent laws.  The foundational pillars of Canadian Medicare — equitable access and preventing two-tier care — could well be vanquished in the process.

2. Wait times: Dr. Day will likely argue that Canada performs poorly on wait times compared to other countries, and that other countries allow two-tier care; thus, if Canada is allowed two-tier care, our wait times would improve.  But this approach is too simplistic.
Common comparisons to the English health system, for example, fail to recall that despite having two-tiers, they have in the past suffered horrendously long-wait times.  Recent efforts to tackle wait times have come from within the public system, with initiatives like wait time guarantees and tying payment for public officials to wait times targets. 

By looking to England we are not measuring like to like but apples to oranges.  English doctors are generally full-time salaried employees while most Canadian physicians bill Medicare on a fee-for-service basis.  Consequently, the repercussions for permitting extra billing in Canada could eviscerate our publicly funded system, whereas this is not the case in England.  Imagine if most doctors in Canada could bill, as those at the Cambie clinic have done, whatever they want in addition to what they are paid by governments?

3. Conflict-of-interest incentives: Evidence suggests there is a danger in providing a perverse incentive for physicians who are permitted to work in both public and private health systems at the same time.  Wait times may grow for patients left in the public system as specialists drive traffic to their more lucrative private practice.

Sound improbable? Academic studies have noted this trend in specific clinics that permit simultaneous private-public practice.  And recent UK news reports have profiled a case where a surgeon bumped a public patient in need of a transplant for his private-pay patient. 

4. Competition: Proponents of privatized health services often claim that it would add a healthy dose of competition, jolting the “monopoly” of public healthcare from its apathy.  But free markets don’t work well in healthcare. Why? Because public providers and private providers won’t truly compete if the laws Dr. Day challenges are struck down.  Instead, those with means and/or private insurance will buy their way to the front of queues.  Public coverage for the poor will likely suffer, as is clearly evident in the U.S., with many doctors refusing to provide care to Medicaid (low-income) patients in preference for those covered by higher-paying private insurance.

Of course, this is all based on an outcome that is not yet known.  It may be that the Charter challenge in BC is unsuccessful but clearly the stakes for ordinary Canadians are very high.  Sadly Dr. Day is not bringing a challenge for all Canadians.  Isn’t it long past time our governments and our doctors work to ensure all Canadians — and not just those who can afford to pay — receive timely care? 

Colleen M. Flood is Professor and University Research Chair in Health Law & Policy at the University of Ottawa and an expert advisor with EvidenceNetwork.ca.  Kathleen O’Grady is a Research Associate at the Simone de Beauvoir Institute, Concordia University and Managing Editor of EvidenceNetwork.ca.


See more at http://umanitoba.ca/outreach/evidencenetwork/archives/23871#sthash.LfJwu9Dk.dpuf

Tuesday, 30 August 2016

CCSN Submission to the Task Force on Marijuana Legalization and Regulation

On August 29, 2016, the Canadian Cancer Survivor Network made a submission to the Task Force on Marijuana Legalization and Regulation. The text of our submission follows.

The Canadian Cancer Survivor Network (CCSN) is a charitable organization of cancer patients, survivors, caregivers, families, friends, community partners and sponsors who work together to take action to promote the very best standard of care, support follow up and quality of life for patients and survivors.

CCSN works to ensure that patients and survivors can easily access tools to understand decision-making processes for positive change on issues critical to optimal patient care; that they are supported to make a difference through working with others to take action on those issues; that they are able to obtain current knowledge about cancer diagnosis, treatment, options and outcomes and are able to work together to end disparities in patient care and treatment.

CCSN and medical marijuana

When the Mahihuana for Medical Purposes Regulations (MMPR) was introduced, CCSN became concerned about patients’ access to marijuana. From that time, CCSN has created resources to provide patients with up-to-date information and educational tools to enable them to understand the swiftly shifting environment.

Currently, CCSN provides information and educational activities on access to medical marijuana through a Medical Cannabis section on its website (http://survivornet.ca/en/cancer_basics) as well as providing updates on medical marijuana as part of its Promoting Cancer Patient Engagement through Educational Webinars series.

Medical users of marijuana

There are several issues related to the medical use of marijuana that are unique and that are of concern to CCSN.

Stigma as an illegal drug

The illegality and subsequent stigma attached to marijuana has influenced how Canadians think about medical marijuana, including those people who may benefit from medical cannabis products. This poses an access impediment to individuals who may benefit from medical cannabis products but who are reluctant to raise the issue with their health care provider (HCP), ask for a prescription from their family doctor or other HCP, or fear recriminations from family members.

An additional stigma can occur if patients are required to smoke marijuana, given that smoking itself has rightfully acquired strong stigmatization of its own. CCSN believes that medical marijuana should be available in many forms so that patients can choose the format that best fits them and to which their illness responds.


Lack of research and clinical trials

Medical cannabis is unique in Canada in that it has not gone through the rigorous health technology assessment (HTA) that all other drugs do through the pan-Canadian Oncology Review (pCODR) for oncology drugs or the Canadian Agency for Drugs and Technologies in Health (CADTH) followed by provincial/territory consideration and approval. The result is that there is a lack of research not only on the effects of medical marijuana but also on the quite different products, given that marijuana itself contains “…hundreds of chemical substances, among which are over 100 known as ‘cannabinoids’.”[i]

Although research on the safety and efficacy of medical marijuana is being conducted, there are still many unanswered questions which often make it difficult for HCPs to prescribe medical cannabis and for patients to be certain that they are deriving therapeutic benefits from it.

Healthcare professionals lack of knowledge about medical marijuana

As mentioned above, the lack of evidence of therapeutic benefits from medical cannabis and their lack of knowledge about appropriate strains and doses has inhibited many HCPs from prescribing medical cannabis, and patients themselves lack knowledge of the different types of medical cannabis being produced in Canada today. HCPs are neither informed nor educated about medical marijuana strains being developed to treat various medical conditions.

CCSN is concerned that many patients who may benefit from medical marijuana are not able to find doctors or other HCPs willing or able to prescribe it, even those HCPs working in areas where there is strong anecdotal evidence and some clinical evidence that medical cannabis has therapeutic value, like oncologists, rheumatologists, orthopedists and HCPs who treat epilepsy as well as family doctors and general practitioners.

Patients lack of knowledge about medical marijuana and continuing access issues

Since there has been a lot of media attention paid to both medical and recreational marijuana in recent years, CCSN is concerned that many individuals who might benefit from medical marijuana are not able to access it legally, and will therefore attempt to access marijuana illegally and use it for medical purposes. This possibility is enhanced when patients are not able to obtain prescriptions from their HCPs. In this situation, patients are in a hit-and-miss situation, given that they have no knowledge of or control over the THC level in the illegal marijuana they have access and the impurities that it may contain.

In addition, medical marijuana users who were growing their own may still have difficulties with the cost of buying from licenced producers and therefore turn to the illegal market. As mentioned above, this leads to lack of control of the THC level in illegal marijuana and the dangers of impurities it may contain. A medical cannabis production and distribution system must be able to offer not only quality but a pricing system that enables and encourages medical marijuana users to buy the product legally. Canadians who choose to grow their own medical cannabis must have a clear path to inexpensive, regular testing of their product so that they know that it is safe and effective to use. CCSN believes that patients should have access to medical marijuana through a variety of distribution sources.



Medical cannabis in a legalized marijuana landscape

The Canadian Cancer Survivor Network strongly supports a separate regime for users of medical marijuana.

The reasons for this recommendation include:

·         The mandates and uses for recreational cannabis and medical cannabis are quite different. 
o   The legalization of recreational cannabis will provide legal access to cannabis while safeguarding product quality and control over distribution, ensuring the safety of youth by limiting access, and establishing pricing to discourage illegal use.
o   Access to medical cannabis is already a constitutional right. Establishing a separate regime for medical marijuana will recognize and validate that the reasons for medical access are indeed different:
§  Medical marijuana access is dependent on a prescription from a healthcare professional for treatment of a specific illness or symptoms.
§  A separate system would bolster the argument that medical marijuana sales should be zero-rated as are other medical devices and treatments.
§  It would leave the door open for third party coverage of medical marijuana through government formularies and insurance benefits.  
§  It would encourage research on medical uses.
§  It would recognize that in some cases, minors benefit from medical marijuana (e.g., treatment-resistant epilepsy in children).
§  It would encourage pricing that would provide access to all patients without anyone utilizing the illegal market.

For additional information, please contact:

Jackie Manthorne
President & CEO
Canadian Cancer Survivor Network
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2X 2B5
613-898-1871
jmanthorne@survivornet.ca






[i] Toward the Legalization, Regulation and Restriction of Access to Marijuana Discussion Paper, 2016.

Monday, 25 April 2016

Transparent Public Pricing for Biosimilars: pCPA Releases First Principles for SEBs

Guest Blog By Arvind Mani
Director of Market Access and Policy Research
PDCI Market Access

The pan-Canadian Pharmaceutical Alliance (pCPA) recently issued a communiqué outlining their initial perspective on subsequent entry biologics (SEBs) and innovative/reference biologics as it aims to establish a SEB policy framework.

 Key Takeaways


It appears that the pCPA’s first principles for SEBs are targeted at ensuring that manufacturers of both SEB and innovative/reference products must negotiate with the pCPA – i.e. not approach individual jurisdictions to seek product listing agreements once the SEB is poised to enter the market.  Further, SEB manufacturers must be prepared for the pCPA to consider evidence beyond regulatory evaluations and health technology assessments (HTA) – perhaps this may involve reviewing international evidence.  Although this may create some uncertainty for SEB manufacturers, it appears that the pCPA balances this with a plan to ensure a competitive market – which may mean some form of preferential listing similar to what was negotiated for Inflectra. 

For manufacturers of innovative/reference biologics, these principles have clarified the pCPA’s expectations by insisting if these manufacturers put forward proposals in response to the entry of an SEB, these proposals provide national value with no incremental costs to any jurisdictions
Finally, the pCPA is clearly moving towards transparent prices for both SEB manufacturers and innovative/reference manufacturers who aim to renegotiate their agreements with the pCPA in anticipation of an SEB entry.  Although confidential product listing agreements are well entrenched and growing in importance for innovative products, it seems that when it comes to the SEB market, public payers are keenly focused on establishing a framework that ensures a greater level of price transparency. 

The table below summarizes pCPA’s negotiation expectations for the respective manufacturers in the SEB marketplace.

SEB Manufacturers
    Innovative/Reference Drug       Manufacturer

National Negotiation –must not approach an 
individual jurisdiction and should focus its negotiation efforts nationally with the pCPA.

National Negotiation –must not approach an individual jurisdiction and focus its negotiation nationally with the pCPA.

Broader Evidence –must be prepared for the pCPA to look at other evidence beyond the Health Canada and HTA information available.
National Value –must seek negotiations focusing on national value – i.e. no incremental costs to any individual province.

Competitive Environment –may benefit from the pCPA ensuring the creation of a competitive environment.

Transparent Price –must be prepared to not only provide a similar value to the SEB, but must include a similar or better transparent price.


Transparent Price –must provide a reduced transparent price.



pCPA First Principles for SEBs (actual communiqué)

The emergence of SEBs in the Canadian market has led the pan-Canadian Pharmaceutical Alliance (pCPA) to begin developing principles to guide more consistent negotiations for these products and related reference biologics, as the pCPA works towards establishment of a SEB policy framework.
The following first principles will guide the pCPA approach to negotiations on SEBs and reference biologics:

·         All SEB and reference biologic manufacturer proposals will only be considered through the national pCPA negotiation process rather than individual or selected jurisdictions. Determination of whether or not to proceed with negotiations with the requesting manufacturer will be made at the discretion of the pCPA.
·         Products under consideration by the pCPA will be informed by Health Canada's regulatory determinations (that the SEB products are safe and efficacious with no clinically meaningful differences with the comparator reference drugs), Health Technology Assessment recommendations, and/or other evidence or considerations as available.
·         Consistent with its mandate that includes increasing patient access to clinically and cost-effective drug treatment options, the pCPA will encourage a competitive environment that includes SEB market growth and is conducive to long-term cost reductions and sustainability for public drug plans.
·         The introduction of an SEB must provide a reduction in the drug’stransparent price to benefit all Canadians.
·         Proposals from reference biologic manufacturers will only be considered if they:
·         Provide overall national value to public drug plans and do not result inincremental costs to individual jurisdictions; and
·         Provide at least similar overall value compared to the SEB, and must include similar or better transparent price reductions if equivalent listing status is sought.
·         These first principles are a starting point and are expected to evolve through the pCPA’s engagement with stakeholders, including the pharmaceutical industry, to develop a more comprehensive SEB policy framework.



Tuesday, 5 April 2016

Why medical marijuana should be exempt from sales tax

The authors are members of the Canadian Medical Cannabis Council patient advisory committee: Lynne Belle-Isle (Canadian AIDS Society), Joanne Simons (Arthritis Society), Cody Lindsay (The Wellness Soldier), Jonathan Zaid (Canadians for Fair Access to Medical Marijuana), Sharon Baxter (Canadian Hospice Palliative Care Association), Sandy Smeenk (Improving the Lives of Children) and Jackie Manthorne (Canadian Cancer Survivor Network).
While Canada engages in complex dialogue about how best to regulate the sale of cannabis for adult use, tens of thousands of Canadians are currently authorized to use cannabis to treat a variety of symptoms and medical conditions. They have obtained this authorization from a physician or nurse practitioner, the only way they can use it legally under current regulations.
Research funded by the University of British Columbia’s Institute for Healthy Living and Chronic Disease Prevention has shown that for many Canadians with chronic medical conditions, a lack of affordability can be a barrier to using cannabis for medical purposes. Sales tax on medical cannabis only adds to the financial burden.
Among research participants who reported buying cannabis for medical purposes, the median amount spent was $200 a month. Likewise, more than half of respondents who currently use cannabis for medical purposes report that they can never or only sometimes afford to buy enough cannabis to relieve their symptoms. The proportion was higher – approximately two-thirds – among those who reported fair to poor general health. Perhaps more importantly, a third of respondents stated that they often or always have to choose between medical cannabis and other necessities, such as food, rent and other medicines.
Health Canada has reiterated that cannabis should be treated like other prescription drugs. Canada’s Excise Tax Act specifies that drugs prescribed by a health-care practitioner that are not available over the counter are zero-rated and not subject to federal and provincial tax. Under the Marihuana for Medical Purposes Regulations, medical cannabis can only be purchased with a medical document obtained from a health-care practitioner. This medical document has been acknowledged as being akin to a prescription by the Colleges of Physicians and Surgeons in Ontario, British Columbia, New Brunswick, Nova Scotia, Quebec and Saskatchewan.
While Canada will likely benefit greatly from the sales tax revenue from the legal adult recreational cannabis market, this should not come at the expense of people who need it for medical purposes. With sales tax unfairly applied and few cost-coverage options available, patients who cannot afford their medicine are suffering.
The removal of sales tax from medical cannabis is a simple and effective first step to increase affordability.
The Canadian Medical Cannabis Council has taken an active leadership role in advocating for this straightforward but critical change. Interim executive director Philippe Lucas has already met with the Ministry of Finance, making the case that removing this financial barrier for those who rely on legal medical cannabis is a low cost, non-controversial investment in the well-being of Canadian patients with a high level of public support, as demonstrated by the 8,000-plus signatures gathered so far in a petition to that end.
As members of CMCC’s patient advisory committee, we represent the interests of people who use cannabis for medical purposes. Together, we join the growing number of voices calling for the minister to treat medical cannabis like other medical necessities and exempt it from sales tax.
Medical cannabis is not just another commodity. For many people, it’s a medical necessity. It should receive the same zero-rating as other prescription medications.