Phamacare round table presentation

1. In an ideal Pharmacare world…
• All Canadians would have prescription drug coverage
• All Health Canada approved drugs would be reimbursed by drug plans
• There would be no copays / deductibles
• Manufacturers would charge cost-effective prices
• All new drugs would have sufficient evidence to demonstrate clinical
effectiveness
• No diseases would have special preference
• Drug plans would have adequate budgets to reimburse costs of all drugs
• All drugs would be reimbursed immediately once approved by Health
Canada
• The HTA process reviewing the clinical and cost effectiveness would be
fully transparent
• Patients would have a clear voice in decision making

2. Pharmacare and Access to Cancer Drugs
• Timely access: No proposal to ensure that drugs are funded
immediately upon Health Canada approval
– HTA process takes up to 18 months
• Evidence based: pCODR is designed for specifically for cancer
drugs – uncertainty tbhat cancer specific plan would continue
under 20/20
• National formulary: 20/20 model wants to integrate single
national formulary into 13+ health plans – fails to account for
provincial health care priorities
– How do we define “national formulary”
– Note that there is already federal / provincial coordination through
pCODR/ pCPA
– National formulary will evolve over time

3. Pharmacare and Access to Cancer Drugs
• All drugs equal: 20/20 model specifies “medically necessary” – no priority
for disease severity, burden of illness, life expectancy
– Practical reality – there are insufficient public dollars to fund all medically
necessary prescription drugs
– Lessons learned: Patient advocacy is necessary to ensure priority for cancer
drugs (e.g., cancer agencies, pCODR)
• Source of Funding:
– 20/20 suggests public only pharmacare will result in significant savings – but at
what cost?
• Lessons learned: limited public only budgets will result in in fewer drugs being
available
– Multiple sources of funding are necessary
– Mechanisms are required to remove / prevent financial barriers to patients