The Canadian Association for Healthcare Reimbursement (CAHR) held its virtual Western Day Conference on February 9th, 2021. Members of the MORSE team attended this conference and have prepared a brief summary of the key highlights. Disclaimer: Please note, this summary is based on our team’s interpretation of the discussion.
This conference was dedicated to Steve Long, who passed away of cancer in 2019. He was a friend, mentor, and collaborator to many within the pharmaceutical market access community in Canada. He was a decorated pharmacist, a respected former provincial drug plan official and a sought-after consultant supporting a range of life sciences-related clients.
Session 1. Inaugural Steve Long Memorial Lecture
Kelly Uyeno, Executive Director, Integrated Health Services Planning & Systems at BC Ministry of Health
Gerry Jeffcott, Senior Associate, 3Sixty Public Affairs
Kelly Uyeno explained BC’s strategic planning to achieve the Pharmaceutical Services Leadership Team’s mission of ensuring the responsible provision of drug therapy across the BC Health System for the best possible patient outcomes from pharmaceutical care.
Continuity of care is extremely important in healthcare, and the pharmacist must be part of this care spectrum. British Columbia has devised an innovative approach to address this issue to be executed over the next five years. There were eight key themes used to guide strategy development: patient access to appropriate medications, pharmacists to be viewed as key healthcare providers, population health planning with attention to social determinants of health, continuity of patient care, formulary management, data & information sharing, research & innovation, and patient empowerment.
Session 2. Patient Group Perspective on COVID & Access in 2021
Dr. Alan Low, Primary care pharmacists and pharmacy lead, BioPro biologics pharmacy; clinical associate professor, faculty of pharmaceutical sciences, UBC
Beth Kidd, Executive Director, Health Coalition of Alberta
Farid Foroud, Director, Health & Life Sciences, Western Canada at Global Public Affairs
Dr. Alan Low spoke to the impact of COVID-19 on patients and patient organizations. The challenges patients are encountering during COVID-19 include uncertainty associated with PMPRB guideline changes, unheard patient voices, and lack of funding for patient organizations. BC has taken measures to create healthcare cost savings through biosimilar switching policies. However, patients are faced with the “nocebo” effect, lack of options regarding biosimilar switching, and mental health impact. Dr. Low concluded that patients should be heard, educated, and supported in order to achieve cost-savings and sustainability for healthcare.
Ms. Beth Kidd raised the interesting observation that although non-profit organizations and health charities are facing great financial and operational challenges brought by COVID-19, demand for services and complexity of client needs have been increasing. To address this challenge, it is imperative to stabilize staff, resources and revenue, obtain government support and form partnerships, as well as re-build, re-assess, and re-imagine patient engagement.
Session 3. PMPRB Update & Panel Discussion
Joan McCormick, Principal for Price Regulation Consulting at IQVIA
Wayne Critchley, Senior Associate, Health & Life Sciences at Global Public Affairs
Kimberly Robinson, Director, Pricing and Market Access, PDCI Market Access
PMPRB experts Joan McCormick and Wayne Critchley spoke to the uncertainties surrounding the PMPRB guidelines. With the recent PMPRB guideline changes, the pharmaceutical industry is facing unprecedented challenges including concerns about transparency and predictability, which may potentially delay decision-making and market access.
Session 4. Virtual Fireside Chat with New CADTH President Suzanne McGurn
Suzanne McGurn, President & CEO, CADTH
Gerry Jeffcott, Senior Associate, 3Sixty Public Affairs
Suzanne provided insight into the ongoing development of CADTH’s next strategic plan, and the possible influence of the COVID-19 pandemic. The strategic plan will be informed by listening to a broad base of Canadian stakeholders, and international groups from which there may be valuable learnings. She emphasized that CADTH’s work will continue to be based on its core competency, evidence delivery geared to the needs of health care decision makers. However, there is the need to expand awareness of CADTH’s current services beyond drug reviews, and to expand expertise to meet new challenges.
Session 5. A view from Cancer Agencies’ Senior Leadership
Kevin Wilson, VP Population Health, Quality & Research at Saskatchewan Cancer Agency
Carole Chambers, Director, Cancer Services, Alberta Health Services Pharmacy
Helen Anderson, Provincial Lead, Systemic Therapy at Provincial Health Services Authority
Stephen Filbey, Founder and Principal Consultant, WestPAR Consultancy Inc.
Kevin Wilson discussed how Cancer agencies such as the Canadian Association of Provincial Cancer Agencies (CAPCA), the Canadian Partnership Against Cancer (CPAC), and the CCRA (Canadian Cancer Research Alliance) are working together and learning from each other. CAPCA is currently focusing on working together across cancer agencies to enhance care, quality, support innovation (highlighting CAR-T therapies) and strengthening sustainability of patient care. CPAC has a coordinated cancer control strategy for the next 10 years. Focusing on faster diagnosis, high quality care, eliminating barriers for treatment and ensuring culturally appropriate care to decrease risk of cancer overall. Lastly, the CCRA brings together cancer researchers.
Carole Chambers highlighted that COVID-19 has forced the Alberta Health System to prioritize. There was a rapid movement to virtual clinics, which is likely to stay. Their centers are running at full capacity and working to reduce chair time. Cancer Care Alberta has seen a 49% growth in patients on compassionate access IV meds during the 2019 year which has also contributed to these pressures.
Oncology biosimilars have been well received as teams were well organized and spoke to clinicians well in advance. Biosimilars were used for all new patient starts, which has contributed to budget savings being on target and growing.
Helen Anderson provided perspective on how COVID-19 impacted cancer screening and care. Initially COVID-19 had led to a moratorium on screening. This picked up by year end, with higher screening rates in some cases. Breast cancer screenings had a total dip in March 2020 and are now higher than they were in the previous year – along with colon and cervical cancer screening. They also saw an initial decrease in referrals, and a growth in demand for systemic therapy. They also saw a dramatic and rapid pivot to remote appointments (from 50 appointments to 450 in March).
In terms of future directions, there has been lots of strategy planning of access, capacity, and quality with patient centered care in a virtual environment. They expect there to be continued collaboration with the pan-Canadian oncology community and see value in aligning across strategies and maintaining consistent cancer care while ensuring the sustainability of the system.
Session 6. Drug Plan Managers Round Table: What has kept you up at night in this past year and what will keep you up in the future?
Chad Mitchell, Assistant Deputy Minister (Acting) – Pharmaceutical and Supplementary Benefits, Government of Alberta
Dr. Tijana Fazlagic, Executive Director, Therapeutic Assessment & Access Branch, BC Ministry of Health
Patricia Caetano, Executive Director, Provincial Drug Programs, Government of Manitoba
Laura Fitzgerald, External Affairs Manager, Western Canada at GlaxoSmithKline Inc.
Patricia Caetano described human resources as a challenging aspect of the 2020 year that kept her up at night. This was due in part to several staff being lost due to deployment for COVID-19 response amongst other reasons. Additionally, she noted the challenges of finding talent with specific experience in this environment.
In the future, there is concern surrounding high cost drugs and the equitability of patient support programs (PSP)– as these programs are not offered for all drugs and patients without a PSP available are often left with the economic burden of paying a high deductible.
For Chad Mitchell, COVID-19 has kept him up at night, especially given the complexities in the current health system. It is challenging to balance the pressures on the drug plan as the population ages, while managing patient expectations, and access to new treatments.
Dr. Tijana Fazlagic
Dr. Tijana Fazlagic noted that COVID-19 has presented challenges, and silver linings. Patients ability to access drugs were impacted, however groups worked collectively to address problems. This led to information sharing with the emerging therapies group to determine how the drug should be used in BC. The group is nimble enough to review new evidence and update guidelines. Working from home initially presented difficulties as well, but teams adapted and continued to produce high quality work.