HESA Committee Report

INTRODUCTION

In December 2006, the House of Commons Standing Committee on Health decided to pursue its study of prescription drugs, commencing with an examination of the status of, and progress made under, the Common Drug Review (CDR). The CDR is the single Federal/Provincial/Territorial (F/P/T) process that is used to review both the clinical efficacy and cost-effectiveness of new drugs. This review process, which takes place after Health Canada has approved a drug for sale, leads to a recommendation regarding formulary listing under participating publicly funded drug insurance plans. All plans participate in the CDR except Quebec. This includes six federal, nine provincial and three territorial drug plans, with the federal government contributing 30% of the CDR funding. It is estimated that between 9 and 10 million Canadians are affected by CDR recommendations on formulary listing.

The six federal drug insurance plans that participate in the CDR are managed by Health Canada (eligible First Nations and Inuit individuals), Veteran Affairs Canada (eligible veterans), National Defence (members of the Canadian Forces), Royal Canadian Mounted Police (regular members and eligible retired members), Correctional Service of Canada (eligible federal offenders), and Citizenship and Immigration Canada (refugee protection claimants, sponsored convention refugees, and individuals detained by CIC). Altogether, these federal plans represent the fifth largest payer of prescription drug benefits in Canada after: Ontario, Quebec, British Colombia and Alberta. Some 1.1 million clients were eligible for drug benefits under the federal drug plans in 2005-2006, at a cost totalling $563 million.

The CDR process does not exist in isolation. It is one of nine key elements of the National Pharmaceuticals Strategy, which is an integrated, collaborative, multi-pronged F/P/T approach to pharmaceuticals within the Canadian health care system. These key elements are intertwined and include, for example, catastrophic drug coverage, pricing and purchasing strategies, evaluation of real-world drug safety and effectiveness, e‑prescribing, etc.

During its hearings on the CDR from April through June 2007, the Committee heard from representatives of federal and provincial governments, the pharmaceutical industry, patient advocacy groups, health professionals, researchers and academics, as well as from CDR officials. The evidence received spanned a number of concerns and included some conflicting views about the CDR. In this report, the Committee summarizes the testimony heard during these hearings, highlights issues raised by witnesses and identifies action needed by the federal government in response to these issues.