Evidence of meeting #49 for Health in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was cdr.
A recording is available from Parliament.
4:15 p.m.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
Does anyone else want to comment on transparency?
Abby.
April 23rd, 2007 / 4:15 p.m.
Abby Hoffman Executive Coordinator and Associate Assistant Deputy Minister, Pharmaceuticals Management Strategies, Health Policy Branch, Department of Health
I could comment briefly on this, although I think the CDR representatives will elaborate in more detail from their vantage point.
I think it's fair to say that if you look at the website where CDR information is posted, the website of the Canadian Agency for Drugs and Technology in Health, you will see there is a lot of information posted there documenting the progress and timelines and the conformity with time targets for review of drugs that CDR has been asked to review. And there are also quite good explanations of the reasons for decision when the CEDAC has provided its advice about whether or not a drug should be listed.
Now, I think there are always cases that can and should be made about whether or not the level of transparency corresponds with contemporary standards, and let's face it, those standards have changed a lot in recent times. But I think at this point, many of us would feel that CADTH and the CDR should be commended for the level of transparency surrounding their management of the CDR program. That's not to say they don't wish to do more—and you can ask them about their plans when their witnesses appear later on. But at the moment, if you want to know why a decision has been taken about a particular drug reviewed through the CDR process, you can get quite a good sense of what factors went into their recommendation just by consulting the CADTH and CDR website.
4:15 p.m.
NDP
Penny Priddy NDP Surrey North, BC
Thank you, Mr. Chair.
I'm going to ask the people who answer to give fairly short answers, because sometimes I don't get to ask many questions, so short answers would be great.
The Federal Healthcare Partnership annual report for, I think, 2005-06 estimated that participating in the CDR saved about $21 million, or something to that effect. You have three different perspectives here, but could you tell me how you think that happened? How did these savings get achieved, because you're really the ones who are saving, because you're the clients in many ways, or your clients are.
So quickly—
4:15 p.m.
Associate Deputy Minister and Chair of the Federal Healthcare Partnership, Department of Veterans Affairs
On behalf of the partnership, the $21 million is not just from the common drug review, but a result of all the things we've been doing around pharmacy. We're doing some things like joint negotiations. So if we go into a province like British Columbia, the six partners, or many of us, will work together to try to have a similar negotiating agreement in that particular province so we will get the same prices.
So the common drug review would only be a part of it. The larger part would be from things like our negotiation strategies—and again, trying to get the best dollar for the drugs we do have listed.
4:15 p.m.
NDP
Penny Priddy NDP Surrey North, BC
Okay, thank you.
Does anybody else want to comment? No? Okay.
My second question, then, is about the common drug review currently expanding to cover, or thinking of expanding to cover, new indications for older or previous drugs, and eventually plans to cover all publicly covered drugs. Can you tell me the impact you think that will have on cost savings for the federal drug benefit plan?
4:15 p.m.
LCol Dave Cecillon
I can comment on that.
If you look at what we're currently doing, we're doing that individually. Again, we would see economies of scale from that. If we're hiring one body to provide us with that information, it reduces our human resources and financial resources requirements by effecting that decision.
4:20 p.m.
NDP
Penny Priddy NDP Surrey North, BC
Okay, so it reduced your costs, because you're currently doing that on your own, right?
4:20 p.m.
LCol Dave Cecillon
That's correct.
4:20 p.m.
NDP
Penny Priddy NDP Surrey North, BC
And you're suggesting that the $21 million saving is in part because of the drug review, but also in part because of other strategies you're putting in place, like negotiating drug costs, etc.
Okay, thank you.
Could you comment on whether you would see a benefit in moving to a national formulary?
4:20 p.m.
Associate Deputy Minister and Chair of the Federal Healthcare Partnership, Department of Veterans Affairs
One of the recommendations from the Auditor General was that we should do more on a common formulary. Through the departments, we have identified the common core formulary.
Again, each department is going to have different drugs. Birth control is one big thing for us right now, and a lot of dementia drugs are not a big thing for the Canadian Forces. We're always going to have different things, but we have identified a core of about 200 drugs that are common to all of our formularies. We can then use those core drugs as a basis for trying to negotiate better prices for all of us.
4:20 p.m.
Associate Deputy Minister and Chair of the Federal Healthcare Partnership, Department of Veterans Affairs
You'll never have one national formulary, but you can have a national core formulary. The cores will be absolutely beneficial.
4:20 p.m.
NDP
Penny Priddy NDP Surrey North, BC
Do you see the difference then only as it relates to the particular client groups that you serve?
4:20 p.m.
Associate Deputy Minister and Chair of the Federal Healthcare Partnership, Department of Veterans Affairs
Exactly.
4:20 p.m.
Executive Coordinator and Associate Assistant Deputy Minister, Pharmaceuticals Management Strategies, Health Policy Branch, Department of Health
Maybe I could comment, not because I have a different opinion but to mention this. Under the national pharmaceutical strategy, which is a joint enterprise of the provincial and territorial governments and the federal government, moving toward a national formulary is one of the objectives of that strategy. I think it's fair to mention that while not all drug plans will access all of the drugs, given the nature of the beneficiaries that might be on that formulary, it's one element.
A second element worth mentioning is that even in the environment of an agreed-on national formulary, I think there will still be decisions made about access on an exceptional rate basis to certain products. I think it's what you've heard a little about here today.
Even if in the majority of cases the recommendations of the CDR are accepted, there still will be exceptions that need to be made, and there are good therapeutic reasons and good efficiency reasons for doing that. There will need to be decision-making structures in place to allow for expert advice to be received on a case-by-case basis to allow for those exceptions. But they would not detract from the value of a core national formulary. We will continue to use CDR, particularly as CDR expands into new indications for old drugs. But even more importantly, class reviews, which we expect will come on stream over the next few years, will significantly assist the eventual goal of a common core formulary.
4:20 p.m.
NDP
4:20 p.m.
Conservative
4:20 p.m.
Conservative
4:20 p.m.
Conservative
Dave Batters Conservative Palliser, SK
Thank you very much, Mr. Chair.
Thanks to the witnesses for being here today.
Hopefully, we'll have time to get back to Ms. Priddy, because she's always very enlightening.
My first question is to Ms. Bruce.
First of all, I'd like to make a quick comment. Following the last meeting, we had a number of comments that the CDR represents a barrier to patient access. The avenue that I'm taking to this study is this. What's going to enhance patient access to pharmaceuticals?
There were comments made that the CDR represents a barrier to access. It provides unnecessary duplication as the provinces do their own reviews. There are significant delays. There's a lack of transparency, a real lack of accountability, and we're learning today that no consistency exists in the process.
Ms. Bruce, if the CDR is working as well as you say it is, why does it have so many critics?
