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Quinn Grundy, an assistant professor at the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing, is examining the use of private infusion clinics for high-cost biological medicines to better understand their impact on the public health system in Canada – and patients themselves.

Biological medicines, a class of drugs that are manufactured from living organisms or their cells, are some of the most expensive drugs on the market – and Canada pays among the highest costs per capita compared to other high-income countries.

Often administered intravenously due to their instability, biological medicines are prescribed to treat autoimmune conditions and are used as chemotherapy or oncology drugs, or to treat other rare diseases.

Grundy says that when these drugs first came to market, drug manufacturers set up exclusive networks of third-party, private infusion clinics to encourage their use and offered a range of supports for patients who were prescribed their drugs.

“In Canada, if you are prescribed these biological drugs you will likely receive infusion care that is paid for by the manufacturing drug company,” says Grundy, whose research is supported by a grant from the Canadian Institutes of Health Research. “We want to understand the oversight around these private infusion clinics, who is funding them, the perspectives of referring and infusion clinic health-care providers, and the experiences of patients receiving care.”

Biologics currently account for the largest – and growing – proportion of drug spending, threatening the sustainability of public drug plans. In recent years, “biosimilar” alternatives to these drugs have become available and many provinces are eager to switch to these cost-effective alternatives.

However, access to infusion care is tied to the drug a patient is prescribed. Grundy’s research aims to address questions about the potential impact of these clinics on continuity of care, privacy of data and quality of care. These are questions she says we need to be asking if these clinics have become the default option for people prescribed this class of drugs.

Grundy will be conducting an environmental scan to document the landscape of private infusion care delivery and oversight in Canada in addition to recruiting individuals who work at these clinics, refer patients to infusion care, or are themselves recipients of private infusion care. She will conduct interviews to better understand how care is co-ordinated and delivered.

As Canadians begin to think more seriously about pharmaceutical care, Grundy says that it is imperative we gain a better understanding of policies around medication access to ensure not only equitable access, but transparency and accountability on the part of all parties involved.

When we study care, it is important to ground our understandings in the experiences of people who give and receive that care and make it visible," says Grundy. "I think we have taken care for granted, and it needs to be sustained and valued, and that includes ensuring it is delivered equitably.”