Public reimbursement policies in Canada for direct-acting antiviral treatment of hepatitis C virus infection: A descriptive study.

Background: Direct-acting antiviral (DAA) therapies have simplified HCV treatment, and publicly funded Canadian drug plans have eliminated disease-stage restrictions for reimbursement of DAA therapies. However other policies which complicate, delay, or prevent treatment initiation still persist. We aim to describe these plans' existing reimbursement criteria and appraise whether they hinder treatment access. Methods: We reviewed DAA reimbursement policies of 16 publicly funded drug plans published online and provided by contacts with in-depth knowledge of prescribing criteria. Data were collected from May to July 2022. Primary outcomes were: (1) if plans have arranged to accept point-of-care HCV RNA testing for diagnosis; testing requirements for (2) HCV genotype, (3) fibrosis stage, and (4) chronic infection; (5) time taken and method used to approve reimbursement requests; (6) providers eligible to prescribe DAAs; and (7) restrictions on re-treatment. Results: Fifteen (94%) plans have at least one policy in place which limits simplified HCV treatment. Many plans continue to require results of genotype or fibrosis staging, limit eligible prescribers, and take longer than 1 day to approve coverage requests. One plan discourages treatment for re-infection. Conclusion: Reimbursement criteria set by publicly funded Canadian drug plans continue to limit timely, equitable access to HCV treatment. Eliminating clinically irrelevant pre-authorization testing, expanding eligible prescribers, expediting claims processing, and broadening coverage of treatment for reinfection will improve access to DAAs. The federal government could further enhance efforts by introducing a federal HCV elimination strategy or federal high-cost drug PharmaCare program.

"That's why people don't call 911": Ending routine police attendance at drug overdoses.

Research has shown that police attendance and the corresponding threat of criminal charges are major deterrents to people seeking emergency medical assistance in the event of an overdose. In response to these barriers, Canada passed the Good Samaritan Drug Overdose Act in 2017, providing immunity from prosecution for simple drug possession to overdose victims or bystanders who phone 911. In theory, this should make people more comfortable seeking emergency supports, but in practice our research found that many remain hesitant because police continue to be routinely dispatched to the overdose site. Based on focus groups and surveys with 109 people who use drugs across Ontario, Canada, our findings show that the vast majority of participants have negative interactions with police, which discourages them from seeking medical assistance at future overdose incidents. Almost all questioned the necessity of dispatching law enforcement to a health emergency that requires medical intervention. As such, this commentary draws on the study's qualitative data to argue that ending routine police attendance at drug overdoses in Ontario would remove a major barrier to calling 911, and thus prevent the further, unnecessary loss of life in the ongoing overdose crisis.

Canada moving backwards on illegal drugs.

Internationally, illegal drug use remains a major public health problem. In response, many countries have begun to shift their illegal drug policies away from enforcement and towards public health objectives. Recently, both the Global Commission on Drug Policy and the Supreme Court of Canada have endorsed this change in direction, supporting empirically sound illegal drug policies that reduce criminalization and stigmatization of drug users and bolster treatment and harm reduction efforts. Until recently, Canada was a participant in this growing movement towards rational drug policy. Unfortunately, in recent years, policy changes have made Canada one of the few remaining advocates of a "war-on-drugs" approach. Indeed, the current government has implemented a number of new illegal drug policies that contradict well-established scientific evidence from public health, criminology and other fields. As such, their approach is expected to do little to reduce the harms associated with substance use in Canada. The authors call on the current government to heed the recommendations of the Global Commission's report and learn from the many countries that are innovating in illegal drug policy by prioritizing evidence, human rights and public health.