Canadians among the last to benefit from new advances in medicine

Many Canadians may not know it, but when it comes to choosing the most advanced medicines, they face barriers that are invisible to almost everyone.

I am referring to the Common Drug Review (CDR), a process that when set up in 2003 was supposed to reduce duplication and ensure that Canadian patients who rely on provincial or federal drug plans have access to the best possible treatments in a timely way.

The result has been the opposite. An international comparison validated by a health management firm has found a huge access gap between Canada and other developed countries in providing patients with health choices.

The reality is that the CDR has become a roadblock, preventing access to innovative medicines nearly twice as often as other developed countries. The comparison looked at 50 new medicines that had been approved by health regulatory bodies in the comparator countries.

In Sweden, 82 per cent of those medicines were recommended for patients. In Switzerland, the figure was 80 per cent. In the U.K., the rate was 76 per cent, and in France, 58 per cent. Even in the United States, 72 per cent of the drugs sampled were available through public plans in Oregon and Ohio.

Canada ranked near the bottom, recommending just 52 per cent or 26 of the 50 new medicines. Among those medicines blocked by the CDR process were new treatments for diabetes, asthma, osteoporosis, migraine and cancer. What is more troublesome is that the provinces (Quebec doesn’t participate in CDR) increase the access gap even further by taking an average seven months to make a decision and by rejecting CDR’s positive recommendations 61 per cent of the time. Is it any wonder that patient groups across this country are concerned about inequality and lack of access to the most advanced treatments?

These decisions affect 10 million Canadian patients. And yet the CDR process remains remote to most of us and lacks in transparency and accountability to patients.

The question is why is it that the Common Drug Review is reaching different conclusions about the value of a new medicine than agencies in other countries? At the heart of the problem is the CDR puts cost containment ahead of patient needs in its decision-making. There is no evidence that this process improves patient outcomes or provides more cost effective medical care.

As a result, the CDR process has left Canadian patients and their doctors with far fewer treatment options. This is unfortunate because, when it comes to medicines, each patient reacts differently. One medicine doesn’t fit all. We need to deliver the right treatment to the right patient at the right time.

Health Canada is responsible for approving drugs based on safety and efficacy. We have another body known as the Patented Medicines Price Review Board that ensures the price of new medicines is not “excessive.� We have to ask ourselves as a matter of good health policy, do we need another level of duplication that acts as a roadblock to innovation?

Federal, provincial and territorial health ministers met in Moncton, N. B., on Dec. 9 to discuss, among other things, a pharmaceutical strategy. Rather than expanding this flawed process, governments must step back and do a full analysis to determine CDR’s effectiveness in improving patient outcomes. This cost-effective analysis needs to determine why the CDR has failed patients, why it has not made innovative new treatments available as quickly and efficiently as possible, and why it has not increased the equality of access to medicines across Canada.

The CDR’s approach ignores the fact that new medicines are both effective and cost effective: for every dollar spent on innovative medicines, seven dollars are saved in other parts of the system, be it through reduced hospitalization, prevention, or helping patients get back to their families and work more quickly.

We are also concerned that the CDR process — through low approval levels — acts as a disincentive to more life-sciences research here in Canada that can lead to new treatments for Canadian patients. This research also creates high-paying jobs and economic growth in an environmentally friendly industry. New medicines that improve and save lives won’t help anyone if they don’t even make it to the pharmacy shelf. And yet that’s what’s happening far too often in Canada.

Clearly, we need to create a system that breaks down administrative barriers that thwart patient choice and access to innovative medicines. We are prepared to join governments, health providers and patients to achieve this goal.

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Russell Williams, the former MNA for Nelligan, is president of Canada’s Research-Based Pharmaceutical Companies.