Health Committee on April 23rd, 2007

[Verna Bruce]

From my perspective, I guess the CDR is really looking at bringing new drugs onto the market. It provides us with information on whether or not a particular drug is more cost-effective than anything else out there.

If I step back to where we were before 2003, it was taking a lot longer to get decisions made on whether or not a drug would be added to one of our drug plans, for example, because we didn't really have the expertise. Instead of it taking 300 days, it could've taken 600 days. I don't know the actual number, because we would have to try to get the information ourselves. The timeframes have actually come down dramatically. The benefit for the pharmaceutical companies is that they don't have to come to each one of us individually to try to make the case. They can make the case in front of a common drug review.

[Dave Batters, Conservative, Palliser, SK]

Thank you.

The decisions are certainly not unanimous. A positive recommendation from the CDR doesn't necessary mean a positive recommendation from the provincial plan. There seems to be no consistency from level to level.

I want to pick up where Ms. Brown left off on the study conducted by Wyatt Health Management, commissioned by CARP. She covered the 73 drugs that were submitted in terms of the CDR's positive listings. Out of the 73 submissions, the CDR made 26 negative recommendations. One drug was withdrawn by the manufacturer, leaving participants with 25 negative recommendations.

Despite the negative recommendations, the federal government provides coverage for all 25 drugs to veterans, whom you represent through Veterans Affairs. In contrast, only three drugs are reimbursed under the drug plans available to first nations, the Inuit, and the Canadian Forces.

I have a couple of comments.

We have 73 drugs that are studied. This is supposed to be an evidence-based medicine approach with experts. We have 25 drugs that are recommended to not be covered, or negative recommendations, that are all covered for veterans. I don't understand that. I would be anxious to hear your explanation.

As well, if I were the gentlemen who sit to your right and to your left, I'd feel somewhat shortchanged by this whole process, although I guess the process seems to be working the way it should for them.

Can you explain to this committee the discrepancies in the listing decisions of federally funded drug insurance plans following CDR recommendations? More particularly, can you explain why the federal program for Veterans Affairs enjoys broader coverage than the other federal programs?

Last, can you explain why the Veterans Affairs plan would allow for reimbursement of drugs that were recommended by the CDR to not to be reimbursable? I'd like some examples of what those drugs might be.

Mr. Chair, it's a serious question. We have 25 negative recommendations, all of which are funded by Veterans Affairs. I'd like some examples of those drugs as well.

[The Chair, Conservative, Rob Merrifield]

Let's ask for an answer, because you took over four minutes in the question.

[Verna Bruce]

The information in the CARP article is actually wrong, so I'll start from that. In fact, of the 25 drugs that were not recommended to be listed, none of them have been listed by Veterans Affairs Canada. So as I was explaining earlier, the information is actually incorrect. They are not listed drugs. Similar to other people, though, if we have individuals who could benefit from the drugs, we will look at them on a case-by-case basis, but they are not listed on the formulary and they're not available to all.

[Dave Batters, Conservative, Palliser, SK]

I have one last quick question, Mr. Chair, to anyone who wants to respond.

Have there been drugs turned down by the CDR that you really would have liked to see approved? This question is to all three of you.

[LCol Dave Cecillon]

On behalf of DND, no, there were no drugs that were not approved that I would have liked to see on the....

[Dave Batters, Conservative, Palliser, SK]

Okay.

Mr. Potter.

[Ian Potter]

We're satisfied with the decisions of the CDR. As I said, in two cases where they had turned down a drug, we thought there was a reason that our particular clientele would benefit and that we would have a cost-effective situation where maybe generally it wouldn't exist.

[Dave Batters, Conservative, Palliser, SK]

Were you able to seek redress on those two examples?

[Ian Potter]

No. The CDR is a recommendation, and we take the advice of the CDR fully. We see across the country much greater consistency in the drugs that are listed, but we do see that some plans have a unique clientele, and in those cases, there may be a reason.

[Dave Batters, Conservative, Palliser, SK]

Ms. Bruce, do you want to comment?

[Verna Bruce]

Again, Veterans Affairs Canada lists all the ones that are recommended to be listed. We don't list the ones that aren't recommended to be listed. Like others, we have a case-by-case review mechanism.

[Dave Batters, Conservative, Palliser, SK]

I'd like to state, Mr. Chair, before we move on, that there's a huge gap between the information that was supplied to us here from our very capable researchers and the information that was relayed to us by Ms. Bruce. I'd like to have some kind of explanation of why, on page 8 of the Library of Parliament's notes, the briefing notes that we received prior to this meeting, there's a huge discrepancy between the information given here and the testimony we've heard. I'd like to have some kind of explanation as to why that is.

[The Chair, Conservative, Rob Merrifield]

Okay. You can ask that question at, I believe, the Thursday meeting.

[Odette Madore, Committee Researcher]

This is a study that was commissioned by CARP, and it was done by Wyatt Health Management. So if there is an issue of methodology, maybe we need to ask those people who have done the study. Or maybe we need to ask—

[Dave Batters, Conservative, Palliser, SK]

Thank you, Mr. Chair.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Ms. Kadis.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you, Mr. Chair.

On the question of whether there is duplication in terms of hopefully better health outcomes for clients and Canadians, I'm interested in knowing why, although the Federal Healthcare Partnership has representation on CDR, at least three of the federal drug plans do not? I'm not clear on that.

There also seems to be some discrepancy there as to why two organizations—I'm forgetting which two—I believe, have representation on behalf of the organization, but the others are all separate.

[Verna Bruce]

Sure. Through the Federal Healthcare Partnership, we as federal government departments are actually trying to work together and we try to support and help each other. There are three big players who want to represent themselves, and that's perfect. There are three other smaller players, from the drug perspective, who don't have the resources to dedicate to actually attending the committee meetings, so we have the pharmacists from the Federal Healthcare Partnership helping them by representing their interests at the committee.

[Susan Kadis, Liberal, Thornhill, ON]

In terms of funding, because I believe we will be seeing the estimates soon, upcoming in a meeting shortly, how much was spent by the federal drug plans in reviewing new drugs prior to the creation of the CDR? In particular, where does the federal funding actually come from, and where will it appear in the estimate documents?

[Ian Potter]

I don't have the precise numbers. We could work to see if we could get an estimate. I think it may be difficult to go back in time and find out exactly what has happened, because it was part of some person's job and now they've moved. As I said, they're spending more time on safety issues, where they were spending more time on approval issues.

But if the committee would like, we could put some effort into trying to determine what we're spending now and what we were spending then.

[Susan Kadis, Liberal, Thornhill, ON]

I think, in the name of transparency, the committee would appreciate that.

Where can we find the funding in the estimates?

[Ian Potter]

Excuse me, I didn't get that. Where in the estimates—?

[Susan Kadis, Liberal, Thornhill, ON]

Where in the estimates can we find the funding for CDR?

[Abby Hoffman]

With respect to the federal share of costs for CDR, they will be found in a named grant that goes to the Canadian Agency for Drugs and Technology in Health, and the CDR is a relatively small proportion of that total annual contribution. You will find it in vote 5 of the Health Canada estimates.

What I'm sorry I can't tell you right off the top of my head is what the disaggregation of those vote 5 contributions is, but in any event you would see, among the organizations benefiting from vote 5 contributions, that the host organization and the amount that's directed to CDR in the current fiscal year is $1.55 million from the federal government. We are the second largest contributor after Ontario.