Cost, effectiveness and the value of innovation
Innovative Medicines Canada and our members recognize that drug plans in Canada are facing increasing pressures to continue to provide the Canadians they serve, with the world class healthcare they desire, in a sustainable way.
There has been significant public discourse over the years on cost and value and how we measure effectiveness when it comes to precious healthcare dollars and more recently, a significant portion of that dialogue has been focused on prescription medicines as a stand-alone issue.
Canada is one part of a global regulatory network that is in many places undergoing significant changes directed at ever faster approvals of important new therapies. Canada’s system also has priority review programs for novel treatments that have shown to meet unmet medical needs or drastically improve patient care. The products that don’t qualify for this priority review continue along a robust regulatory process of clinical assessment, safety review, and pricing for use.
New products to a therapeutic class go through a review process to ensure that they are priced no higher than existing products in the class. This allows follow-on products to provide additional innovation while promoting competition in the marketplace and greater choice for doctors and patients to select the best available treatments at the time.
Today’s process also includes a health technology assessment (HTA) that is designed to assess “clinical effectiveness, cost-effectiveness, and the ethical, legal, and social implications of health technologies on patient health and the health care system.” This data is crucial and supports the development process and clinical trial evaluations that companies implement across the globe.
Just this week a conversation has been started about including “effectiveness” or an HTA-like review process, within regulatory, efficacy and safety approval. In a sense, this notion is putting the cart before the horse, as we can’t have real-world effectiveness reviews if new products are not in the market to evaluate. Relying on other countries to produce this data would not only significantly delay approval and access of new products to Canadians but would then put our processes even more out of step with the other healthcare systems we want to compare to.
Every step of the regulatory process in Canada is designed to evaluate, compare, measure and ensure Canadians receive the best value for new innovative pharmaceutical therapies. These processes are not perfect. They can sometimes be slow and often duplicate the work done by other jurisdictions like the EMA and FDA.
Despite this, discussions around new medicines in our publicly funded healthcare system have focused on narrow cost containment policies that will only result in short term savings that ultimately reduce the flow of new medicines in the system and eliminate patient and physician choice. At 6.4% of total healthcare spending, the cost of innovative medicines in our public health system has finite room to provide any substantial savings without directly impacting patients.
We are at a critical junction point where we must decide how we want to proceed with healthcare quality and innovation in Canada. If we limit ourselves to focus only on costs in one area of the healthcare system, we will miss out on the grander opportunities that the promise of science and innovation offer for improved health.
We are ready and willing to work with Canadian governments and health plan providers to help build systems for Canadians that not only value innovation but are innovative themselves. We need to ensure the best emerging technologies are available and that the system is equipped to determine their effectiveness with all factors considered, in a way that builds from the data we know, to the information that can be used for future decision making.
We welcome the opportunity to bring together the key players in our healthcare system to have a more fulsome discussion on how to build these solutions.
Elaine Campbell is Interim President of Innovative Medicines Canada.