Pricing and reimbursement in Canada: a market access update

Here’s our round up of healthcare market access news from Canada over recent months.

  • the evolution of a National Pharmacare plan
  • expanding use of biosimilars to offer coverage for more treatment options
  • health technology re-assessment plans from the Canadian Agency for Drugs and Technologies (CADTH).

The Canadian government has announced long-awaited drug pricing reforms, which they expect will save more than $13 bn over 10 years on patented drug costs.1

Coming into effect July 1, 2020 the new regulations are expected to:

  • change the reference countries the Patented Medicine Prices Review Board (PMPRB) uses for price comparisons
  • require companies to disclose the actual drug price rather than the list price
  • allow the PMPRB to assess a drug price against its value.

The PMPRB is now re-drafting its guidelines in response to this change and undertaking a consultation.2

The news of the Canadian healthcare pricing reform follows several months of pricing and reimbursement developments, including:

Advancement of the National Pharmacare plan initiative

The National Pharmacare plan conversation progresses with the June release of the final report of the Advisory Council on the Implementation of National Pharmacare.3

This reiterated the interim report’s three key recommendations underpinning the creation of a universal, single-payer public system:

  • a new national formulary
  • a new health technology assessment (HTA) and pricing agency
  • a rare drugs strategy.

The government will now consider the recommendations. We will monitor the developments and see if/how these recommendations are adopted following the federal elections in late 2019.

>> Follow us on LinkedIn as we monitor the developments

Expanding use of biosimilars to offer coverage for more treatment options

British Columbia (BC) announced in May it will seek to expand the use of biosimilars to allow spending on other therapies.4 BC PharmaCare patients will be required to switch to biosimilars from the reference products by late November.

“We know that our use rates can be much higher,”5 explained BC Minister of Health, Adrian Dix. “For example, the biosimilars for infliximab (known as Inflectra and Remsima) have a combined 5–10% use rate in Canada after four years on the market, compared with Norway (98%), United Kingdom (90%) and Scotland (85%). As a result, in 2017, Canada spent over $1.1 bn on the original biologic drug called Remicade.”

CADTH’s proposed HTA re-assessment framework

For the planned HTA re-assessment procedure, CADTH6 has outlined:

  • potential initiators (manufacturers, tumor groups, public payers, cancer agencies, pCPA)
  • potential triggers (new evidence, new comparators, new implementation challenges).

CADTH has noted that in the future, outcomes-based reimbursement agreements might also mandate reassessments

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