File Name: bankruptcy and insolvency act asthma.zip
- Coronavirus and the Workplace: What Employers Need To Know
- Market Intelligence Report: Combination Inhalers for Asthma, 2018
- Insolvency And Bankruptcy Essay
- Insolvency And Bankruptcy Essay
Coronavirus and the Workplace: What Employers Need To Know
As I trudged up the famously crooked Lombard Street, I was disheartened that I could not keep up with my friends. Despite exercising regularly, I was short of breath and had to stop to stretch out my cramping left leg. Two days later, my breathing had not improved. I visited my internist, who quickly diagnosed me with a pulmonary embolism. Luckily, after 3 days in the hospital, I was discharged home.
Six months later, I finished warfarin therapy and tried to put the experience behind me. Years later, when I became pregnant, I was prescribed low-molecular-weight heparin LMWH to prevent a deep vein thrombosis, given my history of pulmonary embolism. Then, shortly before I became pregnant with my second child, my insurance plan changed.
I remember chatting with the pharmacy technician as she rang me up for my first LMWH prescription during my second pregnancy. This time, the cost to me would not be a predefined copayment amount but instead would be coinsurance, calculated as a percentage of the medication cost. I was stunned. Luckily I had a few days before I was to start the injections. I called my obstetrician to get her opinion on whether unfractionated heparin was an appropriate substitute, given its low cost compared with LMWH.
She noted that, given the severity of my previous pulmonary embolism, available guidelines 1 and my successful previous pregnancy while using LMWH, she would recommend that I stay the course if at all possible. After listening to her reasoning and weighing my concerns— what if I switched to unfractionated heparin and had a clot, or a miscarriage? Would I blame myself? Is the cost savings worth it?
My husband and I decided that we would spend down our savings, then, as needed, put the remaining balance onto our credit cards. We are lucky—we had the savings and available credit to pay for the medication.
But not everyone has the available resources to pay for their medication and navigate financial toxicity, or the financial distress that can accompany medical treatment. The concept of financial toxicity captures the financial impact of illness in different realms—how often people go into debt, declare bankruptcy, or change their lifestyle simply because they cannot afford the treatment costs associated with their care 2.
Most research on financial toxicity has focused on cancer care. There is an established correlation between health-related quality of life, psychosocial distress, and measures of financial toxicity among patients with advanced cancer 3. Cancer survivors report having debt as the result of treatments and reduced medication adherence because they cannot afford medications 4.
Other research has found that cancer survivors have a higher risk of personal bankruptcy than people without a diagnosis 5 and a higher risk of mortality after personal bankruptcy 6.
The need to discuss the costs of cancer care has been recognized by the American Society of Clinical Oncology 7 , and the National Cancer Institute has issued Physician Data Query guidelines for patients on how to handle the financial distress that often accompanies a cancer diagnosis 8.
There are limited data on the extent of financial toxicity for people living with pulmonary diseases such as asthma, chronic obstructive pulmonary disease, pulmonary hypertension, or idiopathic pulmonary fibrosis IPF. Although pharmacy benefit managers can help patients with IPF manage the high cost of medications such as nintedanib and pirfenidone 13 , to date there are no published studies evaluating how the costs of IPF medications directly affect patients and their families.
Previously, I worked at a specialty pharmacy where most of the patients had received a solid organ transplant or were living with cancer, HIV, or hepatitis. I felt confident working with the patients to manage their complex medication regimens and brainstorm the best ways to mitigate the frequent side effects of the medications. But there was one side effect I had no idea how to manage, and that was financial toxicity. One patient had overwhelming nausea and vomiting associated with intravenous chemotherapy.
His doctor prescribed an oral chemotherapy agent, erlotinib, to replace the other chemotherapy regimen. I had no idea what to say. Over time, the costs of cancer treatment had added up, so that by the time he received the erlotinib prescription he had no savings left.
Another patient, prescribed lapatinib for metastatic breast cancer, ruefully noted that if she was going to die anyway, then there was no point in bankrupting her family to pay for her healthcare—and depleted resources was not the legacy she wanted to leave behind. These exchanges stayed with me long afterward, because I was flummoxed. Although we enrolled patients in manufacturer copay assistance programs, such programs are not a panacea.
Recent studies have noted a lack of transparency in eligibility for assistance programs 14 and that a small number of prescriptions actually receive assistance from such programs The advent of the Affordable Care Act helped lessen out-of-pocket burden by introducing spending caps for commercially ensured patients, expanding the Medicaid program, and closing the Medicare Part D donut hole Although this is progress, it does not eliminate financial toxicity.
It may be difficult to consider having a conversation regarding costs of care. For example, the antifibrotic agents pirfenidone and nintedanib for IPF are expensive treatments that may slow disease progression, but they have unclear morality benefits Both drugs come with significant side-effect profiles that may be unacceptable for some patients—thus, a frank discussion weighing benefits potentially slowing disease progression versus risks side effects, expense would allow patients to make a more informed decision as to whether a treatment plan that includes one of these drugs is acceptable to them.
Understandably, clinicians may worry about how a conversation regarding costs of care may be received or perceived by patients. Available research suggests that costs are a pressing concern for patients, and the majority would like clinicians to engage with them regarding costs of care 18 , Are you worried about that?
Considering financial toxicity to be a side effect of treatment may help incorporate its impact into treatment discussions. An alternative therapy or care plan may be needed, by considering a different medication or a referral to resources to help pay for medications. Groups such as the Patient Assistance Network Foundation panfoundation. Pharmacists can also be engaged with the issues of cost; a recent study demonstrated that pharmacists located in specialty academic clinics were able to increase patient access to medications by working with pharmacy benefit managers helping with insurance rejections and by enrolling patients into manufacturer assistance programs An assessment of cost burden, alongside routine questions about patient symptoms and side effects of medications, should be a standard part of usual care.
The costs of care can accumulate quickly, and medications are not the only source of financial strain—imaging tests, hospital stays, and copays for outpatient visits all contribute to cost. Communicate openly with your patients about costs, encourage them to do the same, and be aware of local resources for patients struggling with the costs of care.
Finally, consider financial toxicity as a side effect that may necessitate a therapeutic substitution to improve patient quality of life. Although clinicians often recognize polypharmacy as a concern for the drug—drug interactions and adverse events that may accompany it, we do not look at how the cumulative cost of medications affects patients.
In my experience with high medication costs, I understand that I was lucky—my medication was only needed for a short period of time, and I had the resources to pay for it. Before my encounters with the patient receiving erlotinib, I never thought to ask if medication costs were a struggle for patients and if the cost of their medications created financial difficulty in other parts of their lives.
It took becoming a patient for this lesson to be abundantly clear to me. As a health services researcher, addressing the financial burden of care is a primary focus in my research. I look for ways to optimize safe medication use for patients, addressing the physical side effects of medications as well as the financial ones that may be much longer lasting.
By asking about whether patients are having any problems managing the costs of their care, we can ensure that we are on the same page as our patients to provide high-quality, patient-centered care. Author disclosures are available with the text of this article at www. National Center for Biotechnology Information , U. Ann Am Thorac Soc. Cara McDermott. Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Correspondence and requests for reprints should be addressed to Cara McDermott, Pharm. E-mail: ude. Received Jul 19; Accepted Sep This article has been cited by other articles in PMC.
Associated Data Supplementary Materials Supplements. Financial Toxicity: A Side Effect for Many Patients The concept of financial toxicity captures the financial impact of illness in different realms—how often people go into debt, declare bankruptcy, or change their lifestyle simply because they cannot afford the treatment costs associated with their care 2.
Screening for Financial Toxicity: Starting the Conversation It may be difficult to consider having a conversation regarding costs of care. Patient, Pharmacist, Researcher: Connecting It All Although clinicians often recognize polypharmacy as a concern for the drug—drug interactions and adverse events that may accompany it, we do not look at how the cumulative cost of medications affects patients.
Supplementary Material Supplements: Click here to view. Author disclosures: Click here to view. References 1. Financial toxicity, part I: a new name for a growing problem. Oncology Williston Park ; 27 —81, Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Inst. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis.
Health Aff Millwood ; 32 — Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol. Schnipper LE. J Oncol Pract. Financial toxicity financial distress and cancer treatment PDQ : patient version. Financial burden among US households affected by cancer at the end of life. Carrier E, Cunningham P. Medical cost burdens among nonelderly adults with asthma.
Am J Manag Care. Inhaler costs and medication nonadherence among seniors with chronic pulmonary disease. BMC Pulm Med. Morrow TJ. Idiopathic pulmonary fibrosis: the role of the pharmacy benefit manager in providing access to effective, high-value care. Transparency of industry-sponsored oncology patient financial assistance programs using a patient-centered approach.
Market Intelligence Report: Combination Inhalers for Asthma, 2018
PDF Version - 1. Organization: Public Health Agency of Canada. Breathing is something many people take for granted. However, in Canada, 3. Individuals living with asthma or COPD may experience impaired participation in daily life, school, work, and social activities. Collectively, there is also an impact in terms of lost productivity and health care costs, especially considering the increasing prevalence of both asthma and COPD.
QUT Law Review Volume 17 (1) Special Issue: Personal Insolvency A Fresh to Garfield Barwick's persistent bronchitis with its complications of asthma.
Insolvency And Bankruptcy Essay
Asthma is a chronic condition characterized by cough, shortness of breath, chest tightness and wheezing. Asthma symptoms and attacks usually occur after exercise, exposure to allergens or irritants, or viral respiratory infections. Footnote 1 Risk factors for asthma include: family history of allergies; high exposure to airborne allergens pets, house dust mites, cockroaches, mould ; frequent respiratory infections early in life; exposure to airborne irritants such as tobacco smoke, chemicals and outdoor air pollution ; and low birth weight and respiratory distress syndrome RDS. Footnote 2. In , more than 2.
And Insolvency Essay Bankruptcy. As per the Preamble to the. This was intended to tackle the bad loan problems that were affecting the banking system. Bankruptcy is the legal declaration of Insolvency. In order to declare bankruptcy, a person must file a petition for.
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Insolvency And Bankruptcy Essay
This is asthma caused by dusts or chemicals breathed in from the workplace air. It is a form of allergic reaction. Further exposure triggers a response within the immune system, which results in the condition we describe as asthma.
As I trudged up the famously crooked Lombard Street, I was disheartened that I could not keep up with my friends. Despite exercising regularly, I was short of breath and had to stop to stretch out my cramping left leg. Two days later, my breathing had not improved. I visited my internist, who quickly diagnosed me with a pulmonary embolism.
It is just a matter of time before most employers will have to decide whether and when it is legally permissible to require their respective workforces to return to the office after months of teleworking during the ongoing COVID pandemic. Most employers, however, do not anticipate that an employee would take matters into their own hands and seek a court order permitting them to continue teleworking BEFORE the employer even requires employees to return to the office. The case at issue, Peeples v. Clinical Support Options, Inc. However, employers are likely to see more and more requests of this nature as Americans continue to return to the physical workplace.
PDF | Illness can contribute to financial problems directly, through high the Bankruptcy and Insolvency Act and a licensed trustee to make Asthma. Heart disease. Cancer. Injury. Dental problems. COPD*/Emphysema.
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These targeted analyses are designed to inform policy discussions, aid in evidence-based decision making, and provide Canadians with insight into issues pertaining to pharmaceutical pricing and utilization in Canada and internationally. This edition of the report analyzes the market for inhaled corticosteroid ICS and long-acting beta agonist LABA combination inhalers used in the treatment of asthma. These medicines generate annual sales of over half a billion dollars in Canada and represent close to half of the total sales for obstructive airway disease medicines. Canadian list prices for combination inhalers for asthma far exceed the levels prevailing in many other countries, and in fact, this sub-class tops the list of therapeutic areas with the greatest cost implications due to higher prices in Canada. Asthma is the most common chronic respiratory disease in Canada, affecting over three million Canadians and imposing substantial costs in terms of drug spending as well as lost productivity. This report examines four combination inhalers available in Canada that are used to maintain control over asthma symptoms as part of a continuum of treatment:. The analysis provides insight into the use of these medicines, as well as their market shares, pricing, and annual treatment costs.
Refer to the specific census and withdrawal dates for the semester s in which this unit is offered. It will then address the insolvency statutes of the United States, the U. Bankruptcy Code, with particular emphasis on chapter 11 reorganizations. Then the bankruptcy and insolvency laws of various European countries including, but not limited to, Germany, France, Italy, Spain and the Czech Republic, again with emphasis on their reorganization provisions, as applicable. Then the course will cover the terms, if any, of the various nations statutes on cross border bankruptcies and the UNCITRAL recommended provisions, together with the resulting problems where there are no or conflicting statutes in some countries. Finally, the course will compare the various statutory provisions in these nations together with their adoption, or not, of the UNCITRAL recommended terms and the effect thereof. Students who are unable to meet this requirement due to severe illness or other exceptional circumstances must make an application for in-semester special consideration with supporting documentation.
April PDF - 4 MB. Previous edition Full list of analytical studies. Please note that the statements, findings, and conclusions do not necessarily reflect those of the members or their organizations. NPDUIS reports do not contain information that is confidential or privileged under sections 87 and 88 of the Patent Act , and the mention of a medicine in a NPDUIS report is not and should not be understood as an admission or denial that the medicine is subject to filings under sections 80, 81, or 82 of the Patent Act or that its price is or is not excessive under section 85 of the Patent Act. CEPMB pmprb-cepmb. These targeted analyses are designed to inform policy discussions, aid in evidence-based decision making, and provide Canadians with insight into issues pertaining to pharmaceutical pricing and utilization in Canada and internationally.