Pharmacists receiving short shipments as drug shortage continues

By Laura Osman

THE CANADIAN PRESS

OTTAWA _ Ongoing drug shortages are leaving pharmacies across the country to adjust to short shipments on the fly, according to the Canadian Pharmacists Association.

The association first warned of the possibility of shortages in early March, when supply chains for ingredients and finished medications were disrupted by COVID-19 in China.

While Canada has seen a spike in shortages since then, it hasn’t developed into the emergency situation some health officials had feared.

“(Pharmacists) are managing their inventory as best they can with the product that they’re getting, and nobody is going without medication,” said association spokesperson Barry Power.

That sometimes means finding substitute medications when the top choice is running low, he said.

Drug shortages are not new in Canada, but the pandemic has put added stress on pharmacies. Last year, the association said manufacturers reported about five new drug shortages per day in Canada. That increased to 16 a day by early April.

Meanwhile Health Canada has identified 27 drug shortages that could have a serious impact on the health system, typically because there are few good alternatives for those particular medications. Most of the drugs listed are used in the treatment of COVID-19, such as sedatives, painkillers and drugs being investigated as treatments for the viral disease.

Pharmacists have also reported shortages of certain over-the-counter medications like Pepcid, Power said. An intravenous form of the heartburn medication is being researched as a potential COVID-19 treatment. Another reason for its sudden popularity could be a recent recall of competitor medication Zantac, which might have people reaching for an alternative, he said.

The fact that everyone is still getting some form of the medication they need is likely an indication that drug-rationing measures are working, Power said.

In March the association recommended pharmacies restrict the amount of drugs they dispense to a 30-day supply per patient.

“It’s cut back on the demand for things. So I think there has been definitely a positive impact on making sure that people are still able to get their medications. Maybe not the quantities they want, but they are able to get it,” Power said.

The main drawback is that some patients have had to pay more frequent dispensing fees.

“I’m going to have to decide between test strips and food,” said Siva Swaminathan, a Type 1 diabetic who lives in Toronto.

Managing her condition means taking several medications, and replenishing her supply of needles, test strips and pump supplies.

She lost her income during the epidemic, and now has to pay three times the dispensing fees as usual. That’s left her out of pocket an extra $110 so far.

“It’s really, really expensive to buy the drugs individually without the province stepping in,” she said.

Several provinces have changed the way they provide co-payments to compensate for the added costs, but others like Ontario have not.

Meanwhile British Columbia and New Brunswick have started to return to dispensing 90-day supplies, Power said.

As China reopens its economy, the flow of drugs along the supply chain is improving. But it’s not back to normal yet, he warned, and that’s why the association has not lifted the recommendation to limit dispensing.

“We don’t know what’s going to happen if everybody goes back to a 90-day supply,” he said.  “There’s still a lot of vulnerability in the supply chain.”

Power says the association is working with Health Canada, drug manufacturers and wholesalers to decide when those restrictions should be lifted.

 

 

FDA approves pill for aggressive breast cancer that’s spread

By Linda A. Johnson

THE ASSOCIATED PRESS

U.S. regulators on Friday approved a new drug for an aggressive type of breast cancer that’s spread in the body _ including into the brain, where it’s especially tough to treat.

The Food and Drug Administration said Tukysa, a twice-daily pill developed by Seattle Genetics, is for people with what’s known as HER2-positive breast cancer that has spread and resisted multiple other medicines. This type of cancer is driven by an overactive gene that makes too much of the HER2 protein, which promotes cancer growth.

Each year, about 50,000 people in the U.S. are diagnosed with HER2-positive breast cancer. It’s usually curable, but when it spreads it kills most patients. In up to half of them, the cancer reaches the brain, giving that group such a poor prognosis that they have rarely been included in tests of new drugs.

Tukysa, pronounced too-KYE’-sah and also known as tucatinib, works by attacking cancer cells from inside and outside to block production of the HER2 protein.

“This is basically taking the ammunition out of that weapon,” said Dr. Eric Winer, a Dana-Farber Cancer Institute researcher who helped lead the key patient study and consults for Seattle Genetics and other drugmakers.

In that company-funded study, half the 612 participants got Tukysa along with standard cancer drugs Herceptin and Xeloda. The other half got the two standard drugs and a dummy pill.

In the group getting Tukysa, 45% survived at least two years, compared with 27% in the placebo group. Among the participants whose cancer spread to the brain, 25% were alive after a year versus none in the placebo group.

“It’s a significant advance,” said Winer.

Common side effects included diarrhea, fatigue, vomiting and liver function changes.

Tukysa has a list price of $18,500 per month, or roughly $111,000 for an average course of treatment, without insurance. Most patients don’t pay that, and Seattle Genetics plans to offer financial aid.

Tukysa should be available almost immediately.

 

Insurance companies cut group health plan premiums as claims fall

By Tara Deschamps

THE CANADIAN PRESS

TORONTO _ Canadian insurance companies are slashing premiums in a bid to help small- and medium-sized businesses grappling with COVID-19.

The declining use of dental benefits and some extended health care benefits have pushed the Winnipeg-based insurer Canada Life Assurance Co. to offer premium reduction adjustments for employer-sponsored group benefits plans.

Canada Life President Jeff Macoun said the reductions will be 50 per cent for dental and 20 per cent for vision and extended health care benefits, excluding prescription drugs.

“Unlike premium deferrals, these savings do not need to be repaid later, and reflect that some healthcare service providers have shifted to virtual treatment, while others are offering more limited services,” he said in a statement.

Canada Life said prescription drugs are not included as the services are essential and the number of claims have not dropped.

The company said the premium reductions will be retroactive to April 1 with credits applied to May invoices.

“Over 1 million Canadians were laid off in March alone, and financial insecurity is growing,” he said.

“These premium reductions will give more than 26,000 of our business customers some much-needed financial relief, both to their business and to maintaining valued coverage for their employees.”

Over at Sun Life Financial Inc., credits against dental and non-drug-related extended health care premiums will be offered in hopes of reducing invoices for Canadian businesses, who are already struggling with low cash flow.

The insurance company will offer 50 per cent credit per month against paid dental premiums because most routine dental visits have stopped during the pandemic.

For non-drug-related, extended health care premiums it will offer a 20 per cent credit on each of a client’s extended health care benefits.

“Prescription drug usage has not declined during the pandemic,” said Dave Jones, the senior vice-president of group benefits at Sun Life Canada, in a statement.

“Plan members are using an increased volume of virtual care across their paramedical providers, however usage has still reduced.”

April credit in both areas will be applied to June invoices and Sun Life will continue to assess the offerings on a monthly basis.

Meanwhile, Manulife Financial Corp.’s said in an email to The Canadian Press that all group benefit plan sponsors, including small, medium and large-scale businesses, who have a fully-insured, non-refund benefits plan will be given premium relief.

Manulife will reduce their dental premiums by 50 per cent and their extended health care premium, including prescription drugs, by 10 per cent in the month of May.

Manulife said coverage for plan members will not change and the premium reductions will be applied to regular pre-authorized debit draws for May.

 

Cause for cautious optimism in Canada’s COVID 19 fight, top doctor says

OTTAWA _ While there’s reason to believe the spread of COVID-19 is slowing, Canadian leaders warned Wednesday it was too soon to ease distancing measures, even as the country’s central bank warned the downturn tied to the virus could be the worst on record.

On the day Canada passed the grim milestone of 1,000 deaths, chief public health officer Dr. Theresa Tam nonetheless said there is cause to be “cautiously optimistic” that the rate of growth is slowing.

Tam noted the number of cases in the country is now doubling every 10 days or so, compared to every three days in late March.

But she said Canada still hasn’t reached the peak of the outbreak, and it’s too soon to back off physical distancing measures.

“Coming down from this epidemic curve will be like making our way down from a mountain in the darkness,” Tam said during her daily briefing in Ottawa.

“We mustn’t rush or let go of our safety measures, or the fall will be hard and unforgiving.”

Prime Minister Justin Trudeau warned it would still be several more weeks before the country will be able to consider loosening restrictions that have caused businesses to shutter and put the economy in a tailspin.

Widespread testing and the ability to rapidly track down the contacts of infected people will be key to an eventual return to normal activities, he said.

“We have to be through this first wave sufficiently to be able to know we have the capacity to stamp out and restrict any future outbreaks as they come along,” Trudeau said.

“That means technology, that means better testing capacity, that means continued vigilance _ not just by governments but by all Canadians…. We’re still a number of weeks away from that.”

Trudeau announced New Brunswick company LuminUltra was increasing production of chemicals needed to provide the required weekly supply for COVID-19 tests in all provinces. The country has also received more shipments of the swabs needed for the tests, he said.

Millions have lost their jobs as the pandemic has forced the closure of businesses, and consumer spending has plummeted as people have been urged to stay home to stop the spread of the virus.

Economic activity dropped a record nine per cent in March alone, preliminary data released by Statistics Canada suggested.

The estimate, which is to be refined over time, would be the sharpest decline in the nearly 60 years the agency has kept such data.

Despite the bleak economic news, Trudeau was blunt as he warned that easing restrictions too soon could unleash a second wave of infections just as damaging as the first.

“If we reopen too soon, everything we’re doing might be for nothing,” the prime minister said.

Provinces including Manitoba, P.E.I., New Brunswick, and Newfoundland and Labrador each reported three or fewer new cases on Wednesday, but devastating outbreaks continued to sweep through long-term care centres in other jurisdictions, killing vulnerable seniors by the dozens.

The death toll across the country surpassed the 1,000 mark with the announcement of 51 more fatalities in Ontario and 52 in Quebec.

As of Wednesday afternoon, the country counted more than 28,200 confirmed COVID-19 cases, with over half of them in Quebec.

Premier Francois Legault made a desperate plea for family doctors and medical specialists to help out in long-term care homes, where major outbreaks have exacerbated long-running staffing issues.

Quebec has released a five-page list of seniors residences and care homes with at least one COVID-19 case, including 25 institutions where at least a quarter of residents are infected.

Those include a long-term care home in Laval, north of Montreal, which counted 26 dead and 120 infected.

Ontario, meanwhile, had 98 facilities reporting COVID-19 outbreaks that have together killed at least 145 residents, including 29 who died at Pinecrest Nursing Home in Bobcaygeon, and 27 at Eatonville Care Centre in Toronto.

On the economic front, the Bank of Canada on Wednesday kept its key interest rate target on hold at 0.25 per cent, saying that it is effectively as low as it can go.

It warned the downturn tied to COVID-19 will be the worst on record and the economic recovery will depend on the effectiveness of current measures to bring the pandemic under control.

By Sunday night, some six million people had applied for a $2,000-a-month emergency benefit.

To give a boost to struggling workers, Trudeau expanded the criteria of the Canada Emergency Response Benefit on Wednesday to include seasonal workers, those who are still working but earning less than $1,000 a month and those whose employment insurance has run out.

He said he would also be working with the provinces to raise the salaries of essential workers who earn less than $2,500 a month, which includes many working in care homes.

Cause for cautious optimism in Canada’s COVID 19 fight, top doctor says

OTTAWA _ There is cause for cautious optimism that the spread of the COVID-19 epidemic is slowing, Canada’s top doctor said Wednesday, even as the country’s central bank warned that the downturn tied to the virus would be the worst on record.

Chief public health officer Dr. Theresa Tam said that the number of cases in the country is now doubling every 10 days or so, compared to every three days in late March, which means the epidemic is slowing down.

But Tam warned emerging from COVID-19 would “be like making our way down the mountain in the darkness,” stressing that it was too soon to ease physical distancing measures.

“We mustn’t rush or let go of our safety measures, or the fall will be hard and unforgiving,” she said.

Prime Minister Justin Trudeau said Wednesday that widespread testing and contact-tracing will be key to an eventual reopening of the Canadian economy _ something he said is still weeks away.

“We have to be through this first wave sufficiently to be able to know we have the capacity to stamp out and restrict any future outbreaks as they come along,” he said.

“That means technology, that means better testing capacity, that means continued vigilance, not just by governments but by all Canadians …. We’re still a number of weeks away from that.”

Trudeau announced New Brunswick company LuminUltra was increasing production of chemicals needed to provide the required weekly supply for COVID-19 tests in all provinces. The country has received more shipments of the swabs needed for the tests, he said.

The pandemic has led to an unprecedented economic collapse, forcing the closure of businesses and sharp declines in consumer spending as people have been urged to stay home to stop the spread of the virus.

Economic activity dropped a record nine per cent in March, according to preliminary data released by Statistics Canada.

Despite the bleak news, Trudeau was blunt as he warned that easing restrictions too soon could lead to a second wave of infections just as damaging as the first.

“If we reopen too soon, everything we’re doing might be for nothing,” he said.

Even as the rate of new cases has dropped or stabilized in some provinces, devastating outbreaks have swept through long-term care centres, killing vulnerable seniors by the dozens.

The death toll across the country surpassed the 1,000 mark on Wednesday morning with the announcement of 51 more fatal cases in Ontario and 52 in Quebec.

The largest number of the country’s deaths have occurred in Quebec, which counts nearly half the country’s confirmed cases.

Late Tuesday, Premier Francois Legault’s government released a five-page list of seniors’ residences and care homes with at least one case, including 25 institutions with at least a quarter of their residents infected.

Those include a long-term care home in Laval, north of Montreal, which counted 26 dead and over 120 infected.

In an effort to counter the economic blow of COVID-19, the Bank of Canada kept its key interest rate target on hold at 0.25 per cent, saying that it is effectively as low as it can go.

The central bank’s economic outlook said the speed of the anticipated rebound rests on the shoulders of containment efforts to bring the pandemic under control.

Some six million people had filed claims by Sunday night for a $2,000-a-month emergency benefit for help during the first four-week eligibility period.

To give a boost to struggling workers, Trudeau expanded the criteria of the Canada Emergency Response Benefit on Wednesday to include seasonal workers, those who are still working but earning less than $1,000 a month and those whose employment insurance has run out.

He said he would also be working with the province to raise the salaries of essential workers who earn less than $2,500 a month, which includes many working in care homes.

Doctors threaten to leave Alberta after government cuts to fees

Two doctors in Rimbey plan to move to another province after COVID-19 crisis clears

Some doctors in rural Alberta are threatening to leave the province when the COVID-19 pandemic is over, blaming the Alberta government for cuts to fees for hospital and clinic visits.

Dr. Cian Hackett, a rural generalist in the town of Rimbey in central Alberta, said he plans to leave when the crisis is over.

“The successive cuts to physician services delivered in small hospitals such as in Rimbey, Sundre and Stettler are absolutely devastating,” Hackett said in a Facebook post Sunday.

Hackett said he had thought he would work in Rimbey for 30 more years but has changed his mind.

“If you live in another province and know of a great rural practice opportunity, I would love to hear from you,” he wrote.

Hackett, one of six doctors in the town of 2,100 people, works at a clinic and the emergency room at the Rimbey Hospital and Care Centre.

Physicians feeling ‘disrespect,’ doctor says

In an interview with CBC News Monday, he said the last straw came last week when government cuts to after-hours hospital fees came into effect Apr. 1.

In a typical 24-hour shift in the emergency room, Hackett said, he would see 20 to 30 patients. He said he worked about six of those shifts every month.

Until March 31, he said, he was paid $38.03 for each patient he saw. That fee has now been reduced to $31.

“I think physicians across the province are feeling that disrespect,” he said. “I think rural physicians are feeling it even more.”

Hackett noted that the government has overwhelming support among rural Albertans.

“We’re not seeing a respect for the physicians who work for those patients, and to be honest, I’m not seeing respect for the constituents who voted for these representatives.”

Hackett said the government also cut medical liability reimbursement in half.

Medical liability insurance is required of all physicians, and provides malpractice insurance in case they get sued.

According to the 2020 fee schedule, Hackett said, coverage for a family physician to work in a clinic and an emergency room cost $3,420 a year. Adding  obstetrics coverage increased the annual fee to $8,172. In the past, doctors were reimbursed for all but $1,000 of those fees.

“The slash to that no longer makes it worth it for us to practice obstetrics,” he said. “I’d actually be close to losing money each year if I continue that part of my work.”

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