DRUGS: COST OR INVESTMENT?
Part of the challenges come from having an incredibly complex and multi-layered system. Deborah Brown, president of EMD Serono
Canada, comments that "for such a vast geography with a population the size of California, to have 10 decision makers in healthcare
makes no sense. We are duplicating costs over and over in the healthcare system." Brown also points to the inefficiency in
monitoring prescriptions. "In terms of cost utilization efficiency, I think that adherence must be tackled, particularly with
proper use of medications. Pharmaceutical companies in Canada need to determine if patients are actually taking their medications
correctly or often enough, which would reduce costs. This populace perspective on the freeness of drugs can result in patients
not being adamant about taking medications or having a poor diet. Because EMD Serono is in the specialist area, it is a unique
challenge for us to offer value, particularly given the cost of many of the company's products."
Kevin Leshuk, vice-president and general manager of Celgene Inc
"Regarding the provision of public access and drug approval, Canada ranks 26 out of 32 developed countries," says Valeant
Canada president Jacques Dessureault. "On average, only 20 percent of products get reimbursement. Clinical data repositories
do not even provide a positive response to half of the brands seeking public reimbursement. It is a very tough environment
to do business because of the opportunity of an ageing, socialized, and organized healthcare system combined with pressure
on the system."
Claude Perron, General Manager of Shire Canada
Because health-related products are often considered a simple line-item in a provincial budget, "there is a tendency in procurement
to only look at price," says Brian Lewis, CEO of MEDEC, Canada's national medical technology association. "A device might
have a price that is higher for the operating room (OR) and when you are in a hospital the OR can only grow so much because
budgets are cut into silos there. The downstream effect of the product is that re-hospitalization and retreatment are reduced
because of the device's value but the amount that those considerations are accounted for when products are purchased is not
Barry Fishman, president and CEO Teva Canada
RARE DISEASES: CANADA'S RARE CHALLENGE
One of the most evident examples of the difficulties of Canadian market access is seen with medications for rare diseases.
Canada is the only country in the G8 that does not have a formalized orphan drug policy. There are about 200 medications available
in Europe and the US that are currently out of reach for Canadians apart from a Special Access Program (SAP), which grants
exceptions for quickly needed unapproved (and often expensive) drugs. Orphan drug companies, the majority of which are small,
tend to think that because the price of patented orphan drugs are based on the median price of developed states in the EU,
that Canada's prices are too high, despite having a population bigger than many European countries.
Russell Williams, president of Rx&D
Kevin Leshuk, vice-president and general manager of Celgene Inc., noted that advances in the formalization of a policy must
be in tandem with funded formal access mechanisms to become a reality. "If Canada only improves the front end through R&D
incentives or tax credits without focusing on the intellectual property and reimbursement components then we are not truly
improving the future for patients living with rare diseases," comments Leshuk. "The lack of a formalized orphan drug designation
in Canada highlights us as a laggard country compared to other countries where most if not all have some form of recognized
orphan disease policy."
Paul Lucas, president of Life Sciences Ontario
Claude Perron, General Manager of Shire Canada, points out that "innovative medications need to be seen as what they are:
an investment in our healthcare systems, not a cost. This integration of innovation into the healthcare system should lead
to improved health outcomes and efficient use of resources." As such, Shire Canada has made substantial efforts to establish
itself in the rare disease field, particularly in lysosomal storage diseases.
Jim Keon, president of Canadian Generic Pharmaceutical Association
GENERICS IN CANADA: CHALLENGE OR OPPORTUNITY?
Canada has enjoyed a strong generic industry for decades. The majority of generic drugs sold in Canada are also manufactured
in Canada, with more than 95 percent of manufacturing and research for generics taking place in Ontario and Quebec, employing
more than 14,000 Canadians. In 2012, 63.2 percent of all prescriptions in Canada were filled by generic pharmaceuticals, yet
comprised only 24.4 percent of total drug expenditure (CAD 22.1 billion, or USD 21.38 billion). According to Teva Canada president
and CEO Barry Fishman, "63.2 percent is too low and should become closer to the US level of approximately 80 percent. The
Canadian generic industry and other key stakeholders are working to ensure appropriate levels of generic utilization."
Michael Brogan, president, IMS Brogan
"Both public and private payers encourage the use of generics when they are available, to ensure that healthcare dollars are
allocated effectively," notes Fishman. "We have to get our message of 'same quality, better price' to encourage higher levels
of generic usage in the Canadian healthcare system."
Has Canada’s generics public policy failed?