Health Committee on April 23rd, 2007

[Bonnie Brown, Liberal, Oakville, ON]

The thing that concerns me about this, Mr. Chairman, is that for the first nations health branch, of the 27 drugs approved, apparently only 15 of them are available to first nations.

I think maybe that number was incorrect. What was the number?

[Ian Potter]

We reimburse them for all the drugs that have been approved by the common drug review.

[Bonnie Brown, Liberal, Oakville, ON]

Do you ever fund the drugs that have had a negative recommendation?

[Ian Potter]

We have two drugs that had a negative recommendation. On both of them, as I said, our decision to fund was based on the unique needs of our clientele, which is sometimes different from that of the general public.

[Bonnie Brown, Liberal, Oakville, ON]

My concern is this: the federal government pays 30% of the cost of the common drug review and the federal people here seem to be saying it's good for them, but if it's such expert advice, how come they're funding things that get negative recommendations?

Mr. Chairman, I understand the provinces are doing the same thing. In some cases, they are not listing the drugs that got a positive recommendation from the CDR and they are listing the drugs that got a negative recommendation. If this is all such highfalutin, perfect expert advice, how come nobody is obeying the recommendations? Everybody is doing it, both recommending and not recommending, totally opposite to what the CDR is saying.

What are we paying for here?

[The Chair, Conservative, Rob Merrifield]

Does anyone want to try that one?

[Verna Bruce]

I'd be happy to.

We can take a look at the CDR . My understanding is that they make decisions that are generally good for the highest proportion of people in the population. But as partner departments, we all have different clientele with different needs. So while the majority of recommendations—for example, a drug that's being listed for young women is probably not something we're going to list on our formulary, because we don't have a whole lot of young women as clients just yet. On the other hand, there may be a drug that is not recommended for dementia or a particular disease that we deal with in Veterans Affairs. If our veterans have gone through all of the other drugs without a positive result, our view is that they've served our country and we owe it to them to try to see if this will work. But we've only approved those drugs for 380 of our 132,000 clients.

[Bonnie Brown, Liberal, Oakville, ON]

You don't have to justify what you're doing from the perspective of compassion. No one wants you to be compassionate more than we do. What I'm saying is that if the common drug review is so terrific, how come it hasn't taken those things into consideration?

The provinces would not agree that the general population is well served. They are rejecting the recommendations of the common drug review, listing things that have had a negative recommendation and not listing things that have a positive recommendation.

It isn't the population base. I think all the people who had decision-making power before the common drug review are simply hanging on to it. The only thing in your speech that seemed to be positive was that Prince Edward Island, which is the size of my county in population, is benefiting because they couldn't afford to do this themselves.

[Verna Bruce]

But I think that's also true of the federal partners. We couldn't afford to do it ourselves either.

[Bonnie Brown, Liberal, Oakville, ON]

But what were you doing before?

[Verna Bruce]

We were not taking really evidence-based decisions. We were working with the research. Certainly in Veterans Affairs we don't have the expertise that's available from the CDR to make those kinds of decisions.

[Bonnie Brown, Liberal, Oakville, ON]

Thank you, Mr. Chairman. I think that says everything.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Madam Gagnon.

[Christiane Gagnon, Bloc, Québec, QC]

Good day. I'm somewhat surprised to hear all of you say that are you pleased with the Common Drug Review process. The industry's R&D sector is singing quite a different tune. We're hearing from sector representatives that wait times are too long. Mr. Potter, on the other hand, claims that it now takes less time than before to list and market a new drug.

We also have some figures showing that since the Common Drug Review was instituted, fewer drugs have been listed. In Quebec, where no such program exists, more pharmaceuticals are listed and qualify under drug benefit plans. The figures that I have are quite different from yours.

You stated that in any event, even is a drug was not approved for listing under the Common Drug Review, you would list it anyway and include it in a drug plan. I find your position somewhat contradictory. You seem to be satisfied with the current situation and have no recommendations to make, or concerns to voice about the listing process, about wait times and possible duplication at different levels. I'm a little surprised by this.

For example, I was expecting you to say that some drugs are not available, especially since you have some clients under federal government jurisdiction, and that people are not very happy with the existing process.

Are you saying then that veterans and First Nations are satisfied and that you're not being pressured in any way to make certain drug products available?

[Verna Bruce]

I can speak from the Veterans Affairs perspective.

We obviously have some clients who are not happy with the decisions we take, but again, we are a publicly funded program. We have to be able to make a decision about whether a drug should be provided to every veteran, or whether a drug should be provided to veterans who have a specific need because they've tried other things. To do this work ourselves would cost us a lot, so having the common drug review actually saves us the research work.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Potter, you maintained that you have reduced the amount of time it takes to list a drug product, as I recall, from 500 days to 300 days. Could a new drug product possibly be listed in less than 300 days? In the documents circulated, I noted that in Quebec, where many more products are approved and listed, the wait time is over 200 days.

[Ian Potter]

Yes, we would like to see wait times go down, and we are working to see that they are going down.

You must remember that the common drug review is only dealing with new chemical entities—

[Christiane Gagnon, Bloc, Québec, QC]

I understand.

[Ian Potter]

—and my understanding is that they've looked at around 68 since their inception. And that's against a backdrop of, as I said, a formulary of about 6,000 different drugs that are listed.

So in terms of the access to drugs, we feel our formulary does cover quite broadly the drugs that are available in the different therapeutic classes necessary for first nations and Inuit.

[LCol Dave Cecillon]

In addition, with respect to the common drug review, they'd be best to answer that question. However, my personal experience with them indicates that, for the most part, that timeline includes appeal process timing, so they may be better to address that.

From the time it receives a notice of compliance until the time they make their recommendation does also include an appeal process. If within that appeal process the manufacturer does not meet the timelines, then that further delays it.

But I'm sure they would be best suited to answer that question for you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Mr. Fletcher.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Good afternoon, Mr. Chair.

Thank you to the witnesses for joining us today.

Madam Bruce, I just want to concur in something that you said. Our veterans fought for our country and it's up to us to stand by our veterans once the fighting is done. So I hope that when there is doubt we err on the side of the veterans' health.

There is a frustration, I think, that either the committee has heard or that is behind the scenes. We have the CDR, and sometimes the CDR passes or approves a drug and some stakeholders don't include it, and in another case when drugs are denied, stakeholders do include it or cover it. There's no really clear mechanism or transparency on what makes a drug approvable or not.

I think there's a lot of frustration with stakeholders, be it drug manufacturers or individuals who are required to get these drugs. I wonder if you could talk about transparency with the CDR and about how you feel about the transparency of the organization.

You also referred to several other review committees in your opening remarks, the FPT and DUEAC. Does your program duplicate the work of the CDR by re-evaluating the recommendations through these other committees? This is similar to what I think Bonnie Brown was asking. There does seem to be a bit of a duplication, but perhaps not. Could you clarify?

[Verna Bruce]

Sure, I can try.

The questions around the common drug review are probably best answered by the common drug review, but from the perspective of the partner departments, it is really complicated, there's no question. But when you think about the amount of money we're spending on pharmaceuticals, you want to make sure that the drugs we're providing are, first of all, safe. You want to make sure that a really expensive drug is really going to be worth the extra investment of taxpayers' dollars and that it's not just a more expensive drug that does the same thing, or something not as good even as a drug that's already on the formulary.

So there are different groups that look at the drugs from different perspectives. Then among the six partner departments, we do try to learn from each other, to understand what one department is doing, how that applies to the other. So while it's extremely complicated, each committee has its own particular value that it adds.

The drug utilization evaluation is really important from the point of view of taking a look at people who are really high consumers of pharmaceuticals and trying to take a look at whether there are unintended consequences of so many drugs being consumed by one individual, and again making sure that we have experts who are looking at our data to highlight whether or not we have people who are having problems from drug interactions.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

And on the transparency issue?

[Verna Bruce]

I'd leave that to the common drug review. Again, we have a representative sitting on the common drug review, so for us as a department, we have access to the information. So it is a transparent process for us because we're part of it.

In terms of consumers, again, you would need to touch base with them.