Solutions to reduce reimbursement times in Canada
Both industry and government have a common goal when it comes to delivery of new medicines: to ensure Canadians can access the ground-breaking treatments they need in a timely way. But a new analysis highlights a growing problem with our regulations that puts Canadians covered by public drug plans at a disadvantage compared to other countries.
According to the analysis, between 2011-2016, Canadian jurisdictions covered only 39 per cent of available medicines for public plan beneficiaries country-wide, compared to 95 per cent of available medicines that were covered by the median of 20 comparable OECD countries. What’s more, the lag time between when a new medicine is approved for use in Canada to when it is covered under a public drug plan was nearly twice as long as the median of 20 comparable OECD countries, at 534 days compared to 313 days.
Why do medicines take longer to be covered in Canada compared to other countries? The answer lies in the sequential nature of Canada’s drug review and public reimbursement process. Generally speaking, once Health Canada has approved the product, individual agency reviews are conducted consecutively instead of happening concurrently or before market authorization, as it does in many other OECD countries.
Because public drug plan decisions are not made until after all sequential steps have been completed, patient access is considerably delayed and compromised.1 While time spent conducting Health Technology Assessments and public drug plan decision timelines have decreased (in some provinces), the pan-Canadian Pharmaceutical Alliance (pCPA) negotiation process has lengthened by nearly three-fold.2
This has significant implications for Canadian patients who are waiting to access the latest treatments that could potentially save or significantly improve their quality of life. With policy makers focused only on drug prices, drug access timelines are only getting longer.
To shorten these wait times, Canada needs to take a holistic view and build on the strengths of individual processes to reduce system inefficiencies. By streamlining public reimbursement processes through more parallel review opportunities, and establishing performance standards, we can create more predictable timelines through the entire drug review process. We should also take a broader view of how we calculate the value of a medicine, to not only the patient but to broader health systems and their long term sustainability.
The good news is that the federal government recognizes that smarter regulations are needed. In its 2018 Fall Economic Statement, the government committed to modernize Canada’s regulatory system, in order to make it more efficient, agile and less burdensome, while protecting the health of Canadians.
The other good news is the fact that the pCPA has recently committed to reducing its timelines for completing negotiations to 6 months (26 weeks), down from 12 months.3 This is a step in the right direction, but more work needs to be done.
As an industry we are committed to working with our government partners to create agile drug regulations and reimbursement policies that are predictable, efficient, and support safety. Let’s work together to improve timelines and access to new medicines for Canadian patients.
Sarah Lussier-Hoskyn is a Senior Analyst at Innovative Medicines Canada.
- Sam Salek, Sarah L. Hoskyn, Jeffrey R. Johns, Nicola Allen and Chander Sehgal. Pan-Canadian Pharmaceutical Alliance (pCPA): Timelines Analysis and Policy Implications. Frontiers in Pharmacology. Accepted 31 Dec 2018.
- Innovative Medicines Canada. Canada’s drug review and public reimbursement process is sequential and every step adds to the timeline. June 2018.
- Morse Consulting Inc.