Focused Jurisdictional Scan of Glomerulonephritis Medication Access in Canada: A Program Report

Author:

Naipaul Rohini1,Marques Catherine1,Ng Jenny2,Barbour Sean3,Lo Clifford3,Hildebrand Ainslie M.4,Siu Valerie5,Prasad Bhanu6ORCID,Laurin Louis-Philippe7,Wazny Lori D.8ORCID,Armstrong Sean8,Tran Jaclyn9,Sheffield Maneka9,Jauhal Arenn10ORCID,Hladunewich Michelle A.12ORCID

Affiliation:

1. Ontario Health (Ontario Renal Network), Toronto, Canada

2. Division of Nephrology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Nanji Family Kidney Centre, Sunnybrook Health Sciences Center, Toronto, ON, Canada

3. Division of Nephrology, Department of Medicine, University of British Columbia, BC Renal, Vancouver, BC, Canada

4. Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada

5. Pharmacy Services, Alberta Health Services, University of Alberta Hospital, Edmonton, AB, Canada

6. Division of Nephrology, Department of Medicine, Regina General Hospital, Regina, SK, Canada

7. Division of Nephrology, Department of Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QB, Canada

8. Manitoba Renal Program and Winnipeg Regional Health Authority, Winnipeg, MB, Canada

9. Central Zone, Nova Scotia Health Renal Program, Halifax, NS, Canada

10. Division of Nephrology, Department of Medicine, University Health Network, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

Abstract

Purpose of Program: Glomerulonephritis (GN) is a group of rare kidney diseases that is increasingly being managed with higher cost immunosuppressive (IS) agents in Canada. Ontario Health’s Ontario Renal Network (ORN) oversees the management and delivery of GN services in the province. Stakeholder surveys previously conducted by ORN identified that both clinicians and patients do not perceive access to GN medications as comprehensive or timely. The program conducted a focused jurisdictional scan among 7 provinces to inform ORN initiatives to improve access to GN medications. Specifically, the program examined clinician experience with GN access, public drug coverage criteria, and timelines for public coverage for select IS agents (ie, tacrolimus, cyclosporine, mycophenolate mofetil [MMF], mycophenolate sodium, rituximab, and eculizumab) used to manage GN in adults who live in Canada. Methods: For the selected IS agents, a focused jurisdictional scan on medication access was conducted by ORN in 2018 and updated in July 2022. Information was obtained by searching the gray literature and/or credible online sources for public funding policies and eligibility criteria. Findings were supplemented by personal communications with provincial drug programs and consulting GN clinical experts from 7 provinces (ie, Alberta, British Columbia, Saskatchewan, Manitoba, Ontario, Nova Scotia, and Quebec). Key Findings: Clinicians from different provinces prescribe IS agents similarly for GN indications, despite distinctions in public drug funding policies. While patients can obtain public funding for many IS agents, for GN, most provinces rely on case-by-case review processes. In addition, provinces can vary in their funding criteria and which IS agents are listed on the public formulary. For IS agents that require prior authorization or case-by-case review, timelines vary by province with decisions taking a few days to weeks. British Columbia, with a GN-specific drug formulary, had the most integrated and efficient system for patients and prescribers. Limitations: This scan primarily relied on publicly available information for drug coverage criteria and clinician experience with access in their province. Since this scan was conducted, public drug coverage criteria and/or application processes may have changed. Implications: While patients in most provinces have similar needs and nephrologists similar prescribing patterns, gaps still exist for publicly funded GN medications. Interprovincial differences in the drugs funded, funding criteria, and application process may affect timely and equitable access to GN medications across Canada. Given the rarity of GN, a pan-Canadian funding approach may be warranted to improve the current state.

Publisher

SAGE Publications

Subject

Nephrology

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