Country Report: Canada - Pharmaceutical Executive

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Country Report: Canada

Pharmaceutical Executive


DRUGS: COST OR INVESTMENT?


Kevin Leshuk, vice-president and general manager of Celgene Inc
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."


Claude Perron, General Manager of Shire Canada
"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."


Barry Fishman, president and CEO Teva 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 enough."

RARE DISEASES: CANADA'S RARE CHALLENGE


Russell Williams, president of Rx&D
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.


Paul Lucas, president of Life Sciences Ontario
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."


Jim Keon, president of Canadian Generic Pharmaceutical Association
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.

GENERICS IN CANADA: CHALLENGE OR OPPORTUNITY?


Michael Brogan, president, IMS Brogan
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."


Has Canada’s generics public policy failed?
"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."


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