A call for responses to potentially reform the guidelines of the Patented Medicine Prices Review Board has brought questions about the board’s effectiveness and whether its mandate should be modernized to ensure medications remain affordable in Canada.
The review board’s call for responses noted Canada is facing escalating health-care costs, patented drugs are more expensive than those in many other developed countries – including Australia, the Netherlands and the United Kingdom – and investment in pharmaceutical research and development is declining.
In its response to the consultation, the Canadian Life and Health Insurance Association suggested the review board stop targeting its prices so they fall in line with seven other countries: France, Germany, Italy, Sweden, Switzerland, the United Kingdom and the United States.
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“Rather, the PMPRB should increase its use of market-based approaches to strive for the lowest possible price for Canadians,” wrote Stephen Frank, senior vice-president of policy at the CLHIA. “. . . International price referencing should only be one input into what a non-excessive price should be.”
The organization also wrote that the basket of countries should be changed so it better represents the worldwide drug market, noting Canada’s prices should be closer to the median of the Organisation for Economic Co-
For its part, the pan-Canadian Pharmaceutical Alliance wrote in its response that the term “excessive” shouldn’t only be defined by dollar amounts but should consider socio-economic factors, affordability in relation to gross domestic product and market dynamics. It also argues that costing more than its competitors shouldn’t mean a drug is necessarily excessive.
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“One product with a cost equal or less expensive than another product, whose cost is deemed ‘excessive,’ does not necessarily mean it’s priced appropriately either,” the alliance wrote. “If there are no other drug comparators, the cost of usual care (including supportive therapies, medical/surgical/lifestyle interventions, mobility aids and comfort care) could be used for comparison purposes.”
Like the CLHIA, the alliance suggests including lower international prices – and excluding the country with the highest price – when conducting price comparison. It encourages the review board to work with other jurisdictions to establish confidentiality agreements that would allow countries to share how much they each pay.
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In its response, Innovative Medicines Canada notes the review board isn’t the right agency to decide on the affordability of medicine in Canada, since it’s not accountable for spending decisions, doesn’t pay for medicines and doesn’t have clarity into drug and health budgets.
It also argues innovative medicines are often viewed as a commodity, rather than an investment. “While recognizing fiscal constraints, we should collectively aspire to more ambitious goals,” wrote the organization in its response. “We should aspire to create a marketplace that encourages market entry of novel medicines.
“This approach will benefit both payers and patients. Payers will benefit from greater levels of competition, and patients will benefit from having more options available to them and their health care practitioners.”