Drug Reimbursement Policies in Canada—Need for Improved Access to Critical Therapies

Abstract

Public drug programs in Canada are increasingly implementing cost management strategies. A multidisciplinary review of these strategies--specifically, the special authorization (SA) process--found that implementation of the SA practice is costly and causes inequity in access, underutilization, and delays in treatment for urgently required therapies, all potentially leading to negative health outcomes. We present potential solutions and a set of recommendations for decision-makers to base reimbursement decisions on the best clinical evidence, eliminate regional variability in access, ensure timely access to urgently required treatments, and monitor the impact of reimbursement policies on health outcomes.

Common Drug Review Recommendations

“…For example, aliskiren received a DNL from the CDR based on an absence of data regarding long-term outcomes and safety, [36] but was funded in Ontario based on a confidential agreement addressing price, utilization and evidence development. Nevertheless, the setting for this research included concerns that have been raised in the CDR-and Health Canada-commissioned external reviews, in international comparisons of central review agencies, and in the literature: the worry of patients and physicians that evidence-based funding decisions can give rise to negative health outcomes [41][42][43] and/or are not appropriate for all drugs; [42,44] the pharmaceutical industry concern that innovation is not rewarded; [23] observations of a lower list rate than in comparable nations; [19,20] the need for an appeal mechanism; [17] and the need to attain transparency. [38] This unresolved issue will continue to be a concern, although two very recent CEDAC recommendations noted that their concerns and recommendation would be different at a different price; this type of wording provides a basis for harmonization if a payer decision differs from a CDR recommendation.…”