Nigel Rawson and John Adams | Hill Times | Nov 15, 2023
If the Liberals cave to the NDP’s demands to create single-payer universal pharmacare in order to maintain the supply-and-confidence agreement, the already poor relationship between Canadian governments and the biopharmaceutical industry will be further damaged especially if only so-called “essential” drugs are covered, and not innovative emerging therapies.
Government hostility to the industry is demonstrated by the barriers that drug developers must overcome to get new medicines listed in government drug plans. This includes a lack of federal incentives to submit medicines to Health Canada, protracted health technology assessments (HTAs) that lack accountability and transparency, and slow collective price negotiations. Neither HTAs nor price negotiations provide for independent adjudication of differing views by arbitration or the courts. Even when drugs successfully pass these barriers, government drug plan gatekeepers make the situation worse by slow-walking drugs onto formularies. Patients too often must wait for access to innovative therapies until every ‘t’ is crossed and ‘i’ is dotted at each step—putting process before patients. Other jurisdictions do much better.
As a consequence, developers bring new medicines to Canada later than in the United States and the European Union. Some aren’t launched here at all. The result is that Canadians who need new drugs either have their access long delayed, or denied. This includes medicines for diseases like cancer, amyotrophic lateral sclerosis, and sickle cell disease—where patients don’t have time to wait. Universal pharmacare covering only inexpensive “essential” drugs will not help Canadians with these diseases.
Canada’s health system is built on an antiquated model concentrated on hospital care. Sixty years ago, if you had a heart attack, stroke, or a similar health episode, you were most likely admitted to hospital and often not expected to recover. Today, medicines can prevent or delay risk factors that can lead to major health events.
Our health care administration is still run in compartmentalized budget silos relating to different services instead of being managed as one system focused on patient care and outcomes. Effective drugs reduce the need for in-patient, emergency room, and physician care, but too often governments only look at cost, and ignore the broader benefits drugs can bring—not only to the health and wellbeing of patients and their families, but also to other parts of the health care system, society at large, and the economy.
In line with its hostile mindset about new drugs, the federal government tried over the past six years to introduce regulations that would force drastic decreases in drug prices. This reduced the attractiveness of our biopharmaceutical marketing environment to an even lower level. Canada continues to slip in the global launch sequence as drug developers decide when and where to launch new treatments.
If Canadians are not to endure further wait times and denials of access to innovative medicines, our governments need to change their antipathy towards the biopharmaceutical industry. Other countries have recognized the need to collaborate with the industry rather than try to force regulatory changes.
In Australia, the government has entered into an agreement with drug manufacturer associations “to gain access to breakthrough new medicines as early as possible and to deliver robust and uninterrupted supply of the millions of medicine doses that Australians use and need every day.” The government will provide stability and certainty for investment in new medicines and around HTA processes. In return, the industry has committed to an improved pricing system for the Australian drug plan that will generate savings to be invested in new drug listings.
In South Korea, a commission chaired by the prime minister is being established to foster the bio-health industry by providing systematic support and the latest technologies. The objective is to overcome bureaucratic compartmentalization obstructions that result in fragmented government policies (sound familiar?). All government organizations are to work together on policies and plans aimed at providing support throughout the development and commercialization of health products.
Australia and South Korea, as well as European countries, stand in sharp contrast to the guerilla warfare underway across Canada against the biopharmaceutical industry. Instead of our governments being world leaders in fragmented responsibilities and siloed budget accountability, they need to unite the silos and collaborate with the industry to bring facilities and jobs to Canada, and to allow Canadians the same timely and comprehensive access to innovative medicines that patients in other comparable countries have.
A sketch in the Halloween episode of CBC’s “This Hour has 22 Minutes” ended with the punchline “there’s nothing scarier than Canadian health care.” But there is. It’s the attitude of governments towards the biopharmaceutical industry and their desire for rock bottom drug prices. Universal government-run pharmacare covering only cheap, so-called “essential” drugs would be minimal health care. Manufacturers would be even less motivated to bring innovative medicines to Canada, resulting in increased denials of access for Canadians with unmet health needs. No one wants that.
Nigel Rawson, affiliate scholar with the Canadian Health Policy Institute, is also a senior fellow at the Macdonald-Laurier Institute, as is John Adams, CEO of Canadian PKU and Allied Disorders Inc. and volunteer board chair of Best Medicines Coalition.