Abstract
Public reimbursement systems face the challenge of balancing provision of needed treatments and the reality of limited resources. Canada has a complex system for drug approval and public reimbursement, with jurisdiction divided between the federal government and the provinces/territories. A pivotal role is that of health technology assessment (HTA), which relies primarily on health economic principles to analyze the value of drugs on a population health basis and make recommendations about public reimbursement. The Canadian Agency for Drugs and Technologies in Health (CADTH) provides recommendations to all provinces but Quebec. This article provides an overview of Canada’s approval and public reimbursement pathway, including the role of HTA and the economic principles on which it relies. Starting in late 2020, CADTH reduced the cost per quality-adjusted life year (QALY) threshold, the metric relied upon in making recommendations to public payers. An analysis of all 56 oncology drug final recommendations issued from January 2020 to January 2022 was conducted and confirms this reduction in the cost per QALY threshold. As a result of this threshold reduction, recommendations to the provinces include, in a number of cases, substantially greater price reductions. The potential implications for successful price negotiation with the pan-Canadian Pharmaceutical Alliance (pCPA), the public negotiating body for the provinces, are discussed.
Highlights
Publisher’s Note: MDPI stays neutralOne of the greatest challenges in Canada’s public drug reimbursement programmes is the ethical tension between potentially competing desired goals
A review of relevant literature was conducted to provide an overview of the pathway from drug development to public access in Canada, with a focus on health technology assessment (HTA), including its underpinning health economic principles, and to provide a brief history of the pan-Canadian Oncology Drug Review process
Potential Implications of the Threshold Reduction. This begs the question about what has changed in provincial decision making on this issue, since prior to this change the provinces were relying on recommendations based on seemingly higher thresholds for oncology drugs reviewed at pan-Canadian Oncology Drug Review (pCODR) without any public expression of dissatisfaction
Summary
Publisher’s Note: MDPI stays neutralOne of the greatest challenges in Canada’s public drug reimbursement programmes is the ethical tension between potentially competing desired goals. The other is the reality that the ability to provide targeted treatments is limited by the fact that funds and other resources to do so are not unlimited The implication of this tension includes the reality that individuals may not have access to needed medications through public reimbursement programmes. If they are unable to afford them or do not have private insurance that covers them, they will not get them unless they can access them through some type of compassionate access programme. The complexity in the public sphere is largely, not entirely, due to the division of jurisdiction between the federal government and the provinces/territories with regard to jurisdictional claims in published maps and institutional affiliations
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