Annual Conference of Provincial-Territorial Ministers of Health

EXECUTIVE SUMMARY:

 Overview:

To date, the federal, and provincial and territorial (F/P/T) governments have individually made significant efforts to address the challenges and manage pharmaceuticals in a way that maximizes patient health outcomes while contributing to system sustainability. However, as the responsibility for many aspects of pharmaceuticals in Canada is shared among jurisdictions, there are interdependencies and limitations with respect to what individual jurisdictions can achieve on their own.

Recognizing the growing importance of pharmaceuticals in health care, and the cross-jurisdictional nature of the issues, in September, 2004 First Ministers directed Health Ministers to establish a Ministerial Task Force (MTF) to develop and implement the National Pharmaceuticals Strategy (NPS) as part of the 2004 10 Year Plan to Strengthen Health Care. All Health Ministers (with the exception of Quebec) were included in the MTF under the co-chairmanship of the federal and British Columbia Ministers of Health.

On September 21, 2006, P/T Ministers of Health released the NPS Progress Report to the public with endorsement of the federal Health Minister. On December 9, 2006, F/P/T Ministers of Health agreed to proceed with Phase II of the NPS, and to fund this next phase of work ($2.937M Jan 07/March 08).

The purpose of the NPS is to address the challenges and opportunities across the drug life cycle using an integrated, collaborative, multi-pronged approach to pharmaceuticals within the health care system.

Quebec, having its own pharmacare program, is not part of the development of the National Pharmaceuticals Strategy. Quebec is however open to sharing information and best practices.

Catastrophic Drug Coverage (CDC)

Catastrophic Drug Coverage (CDC) is the area within the NPS that has the broadest public interest. CDC is fundamental to the First Ministers agreement that “no Canadian should suffer undue financial hardship in accessing needed drug therapies.” It was this agreement that led to the direction to develop and implement the National Pharmaceuticals Strategy.

In keeping with this principle, there is a need to establish a national minimum standard of pharmacare coverage for Canadian citizens which recognizes and retains provincial and territorial jurisdiction and autonomy over pharmacare program delivery and design.

Currently provinces and territories either do not have resources to establish pharmacare programs, or face significant fiscal challenges maintaining existing catastrophic prescription drug coverage. With significant cost growth in this area, provinces are increasingly being forced to reallocate resources from priority areas, including education, other health programs and public infrastructure to sustain coverage.

P/Ts are of a common view that Catastrophic Drug Coverage is as essential to Canadians as physician and hospital coverage, the latter two of which are subsidized by the federal government. Accordingly, P/Ts believe that the federal government has a funding responsibility to establish a minimum standard of drug coverage for all Canadians.

Decision sought: to establish a funding formula that supports a national standard of pharmacare coverage for all Canadians and:

   
• protects the flexibility and autonomy of provinces and territories to define program design to best meet the needs and economic realities of their respective populations;
     
     
   
• is based on the principle that provinces/territories will introduce and/or maintain pharmacare coverage where, on average, prescription drug costs will not exceed 5 % of the net income base for their respective populations;
     
     
   
• recognizes the federal government's role and responsibility as an equal partner (50/50) in funding provincial and territorial coverage consistent with the standard - the estimated cost (2006) is $5.03B ($2.52B federal / $2.52B P/T)

Expensive Drugs for Rare Diseases (EDRD)

Public drug programs are challenged by rare disease therapies. Despite low numbers of patients affected by rare diseases, the high per patient costs and limited available evidence establish precedence for what governments are willing to accept in establishing how public funds are used and prioritized.

Jurisdictions want to work together to achieve more consistent access; however, collaborative efforts introduce complexities and difficult policy questions about how to subsidize patients across health systems and establish appropriate public accountabilities.

There are public expectations to take immediate action to improve collaboration and access for patients affected by rare disorders in Canada. The current system is not perceived to be addressing the unique medical needs and circumstances of vulnerable patient populations affected by rare diseases. There is potential migration of patients with rare diseases to those jurisdictions that may offer access and coverage to certain rare disease therapies.

A proposal to implement a Canadian Access Program for Rare Diseases has been developed.

Decision sought: to establish a Canadian Access Program for Drugs for Rare Diseases

   
• Rare diseases defined as a primary hereditary metabolic single-gene disorder (with a prevalence of less than 1.65 per 100,000 CDNs) that is life threatening or severely debilitating, and with a primary treatment available
     
     
   
• Access based on participation in research and monitoring
     
     
   
• Pool expertise and funding (based on 50/50 F/P/T funding formula) with centralized, transparent decision making model with public involvement.

NPS DECISION MAKING DOCUMENT

Common National Formulary (CNF)

The underlying principle is that as CDR reviews a broader scope of drugs and provinces adopt these recommendations on a consistent basis that jurisdictions will become more similar over time.

Agreement sought: to recognize the intent of this objective has been met through the establishment and adoption of the Common Drug Review (CDR) process. There is greater than 90% commonality on what provincial jurisdictions pay for.

Pricing and Purchasing (P & P)

A series of reports have noted important price variations within the Canadian non-patented drug product marketplace. Governments are working together, where possible, to develop approaches that will extract additional value for this sector of the pharmaceutical marketplace for the public.

It is important to balance the implementation of pricing approaches with the need for a transparent, accountable system and viable supply and distribution chain that can meet the needs of Canadian patients and at the same time correspond with jurisdictional economic strategies.

Agreement sought: to recognize a national approach to achieve pricing and purchasing savings is not realistic at this time given the ecomonic development and legislative/policy considerations within individual jurisdictions. Interprovincial collaboratives should be separately pursued and evaluated outside of the NPS.

Real World Safety and Effectiveness (RWSE)

Work on the RWSE activities has progressed to the point at which both the business plan and the proof-of-concept for the Drug Effectiveness Safety Network (DESN) are ready for release. The Federal government considers this area to be of the most importance for the Canadian public.

Agreement sought: to support a federally-funded RWSE program, provide access to necessary data and identify priority drugs for monitoring.