Thank you, Mr. Chairman, and members.
Thank you on behalf of Health Canada for the opportunity to speak to the committee on the topic of the Common Drug Review.
I'm joined by my colleagues Abby Hoffman, the executive coordinator of pharmaceutical management strategies for Health Canada; and Scott Doidge, the manager of pharmacy for the non-insured health benefits program.
Committee members may recall that Health Canada’s first nations and Inuit health branch operates a program for registered first nations and Inuit called the non-insured health benefits program, or NIHB. This program provides a limited range of medically necessary health benefits to approximately 790,000 eligible clients. These benefits include pharmacy and dental services, glasses and other vision care aids, and transportation to access medically required services. The NIHB program plays an important role in Health Canada’s goal of closing the health gap between first nations and Inuit and other Canadians.
Approximately 80% of our clients are low-income earners. They experience a higher disease burden than the national average. For many of them, NIHB is the only available supplementary health benefit program they have.
NIHB is the largest federal non-employee drug benefit program with expenditures of $368 million in the year 2006-07.
Last year, NIHB processed over 13 million pharmaceutical benefit claims. In total, over 500,000 different first nations and Inuit clients claimed the benefit.
In managing this benefit, NIHB maintains a drug benefit list, or a formulary, to determine whether and how to fund pharmaceutical benefits. There are approximately 6,000 distinct products reimbursed under the program. Drug products on the NIHB drug benefit list are categorized as either open—that is, no restrictions if there is a valid prescription—or limited use. Other drugs are reimbursed on a case-by-case basis. The drug benefits list changes on a constant basis to reflect the availability of new drugs, new uses for old drug products, or generic versions of brand name products. Last year, the non-insured health benefits program made more than 600 changes to the drug benefit list.
Almost every day, new strengths or formulations of existing drug products are approved by Health Canada. Manufacturers often change, and generic versions of brand name medicines come to market. To provide advice on existing drugs in our formulary, NIHB looks to an independent expert advisory committee, the Federal Pharmacy and Therapeutics Committee. The committee provides clinical advice to all six federal plans and informs decisions related to delisting and to listing of new uses for drugs. The membership of this independent expert advisory committee includes practising physicians and pharmacists from the community and hospital setting, and it includes three first nations physicians.
The NIHB program also has a Drug Use Evaluation Advisory Committee to provide expert independent advice on appropriate utilization and client safety with respect to drugs listed in the NIHB formulary. This committee reviews utilization trends of certain drugs or classes of drugs and, where appropriate, refers issues of concern to the program. For instance, as a result of safety issues and concerns about potential misuse, NIHB changed the benefit status of Duragesic, a long-acting opioid patch, from open benefit to limited use.
For drug products that are new chemical entries on the Canadian market or for a new combination of existing products, the NIHB program follows the recommendations of the federal-provincial-territorial common drug review. Since 2003, the common drug review has reviewed 68 new prescription drugs. Of the 32 drugs recommended by the common drug review, NIHB has listed or will reimburse the cost of all these drugs for our clients. Twenty-five of these drugs are listed on our benefit list and seven are available on a case-by-case basis.
NIHB always assesses the recommendations made by the common drug review against the mandate of our plan and the unique needs of our first nations and Inuit clients. Given the unique needs of our clients, some exceptions are warranted. That is, they may not be reasonable in the general situation, but they make sense for our clients.
On rare occasions, the NIHB program will list a drug that is not recommended by the common drug review if a client-specific analysis warrants it. For example, to ensure access to oral contraceptives for a high proportion of clients in our program who are of child-bearing age—and our clients are mostly young—NIHB listed a birth control product in the formulary that was not recommended by the common drug review panel. In this case, our pharmaceutical committee reviewed it, looked at the specifics of our clientele, and said that there was a benefit to our clientele and that it should be available.
Through the work of the common drug review process, the NIHB program has been able to eliminate the backlog of new drugs awaiting review.
As a national program that delivers its benefits in ten provinces and three territories, the NIHB program has benefited from increased consistency in listing across jurisdictions, and clear objective standards.
We are also able to make faster decisions on new drug listing, reducing the amount of time to list a drug product by approximately 25%, from an average of 500 days from the day a product receives its marketing authorization to 334.
Because NIHB pharmacy professionals now spend less time reviewing drug submissions, the program has been able to concentrate on other key tasks that have led to important program enhancements, including measures to improve client safety.
Given the interest the committee has shown in the past about NIHB's work to improve safety, I have taken the liberty of circulating a publication called a “Report on Client Safety”, which highlights some of the improvements, for your information.
I have taken the liberty of circulating, in advance of this meeting, a publication called a Report on Client Safety which highlights some of these improvements for your information.
Thank you very much. Merci.