Health Committee on April 23rd, 2007

[Susan Kadis, Liberal, Thornhill, ON]

Thank you, Mr. Chair.

If I still have a moment of two, I'm interested in this new establishment of the joint oncology drug review. In your opinion, what are the advantages of having a separate common drug review for cancer drugs, and what are possible drawbacks as well?

[LCol Dave Cecillon]

In that regard, I think you have to address that through to CDR. They would be best to answer that question.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you, Mr. Chair.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Ms. Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you, Mr. Chairman.

Thanks to each of you for your presentations.

I want to go back and ask this. I think, Ms. Bruce, you had responded to the national drug formulary, but I'm interested to hear what the other two departments feel about that. Is it a good goal to be working towards, or is it something that would be beneficial to your departments?

[LCol Dave Cecillon]

As Ms. Bruce indicated, we have come together to have a core formulary, and based on our different needs, our patient population from 17 to 60, many disease states are not prevalent within our patient population and therefore we do not list those products for those disease states. So that means the difference between us.

I'll let my counterpart from NIHB respond.

[Ian Potter]

We've been seeing the advantage of a national or common core formulary, but as mentioned previously, there are very particular needs of different plans, and those needs show up in the formulary. And I think that was a strength of the system, not a weakness.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you.

Ms. Bruce, the information that came out of the Wyatt health study that was commissioned by CARP has been quoted here a couple of times, and you have stated that those figures are incorrect. I believe the figure we have is that, despite negative recommendations, Veterans Affairs covers 25 drugs that got the negative one, and you're saying that's incorrect. What is the correct number?

[Verna Bruce]

As I understand it, and I'll verify this for the committee, of the 25 drugs that are recommended not to be listed, Veterans Affairs has not listed any of them. And again “listed” means that they're on the list and they're available for everybody to access without any questions being asked. We do have them, though. If a veteran has tried all of the listed drugs and it hasn't worked, then they can make a special request for case by case. So it's not listed on the formulary but it's available on a case-by-case basis.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

In fact, maybe this information isn't incorrect, because it says the federal government provides coverage. So it could be providing coverage if in fact it's a specific incident, case by case?

[Verna Bruce]

But I think the information may not be consistent among the departments. I think for Veterans Affairs, they've taken that case-by-case and made it look like we're listed, whereas for the other departments they may have taken the listing.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Okay, and it says that for first nations, the Inuit, and the Canadian Forces, there are only three drugs reimbursed. Is that figure correct, or is that wrong too?

[LCol Dave Cecillon]

On behalf of DND, I can't comment on the exact number, because again it's a case-by-case basis, and at times you look at the economics between sending a person off to undergo a surgical procedure or putting them on a medication that may help them, and that's how you have to weigh it out. Our mandate is to provide health care to improve patient outcomes, and so that's what we attempt to do.

[Ian Potter]

For first nations and Inuit health non-insured benefits, there are two drugs that were not recommended. One is Lantus, which is a long-acting insulin drug that is on our exceptions list. It's been put there because it is sometimes useful instead of having to go to an insulin pump, which is often difficult given the location of our clients. The second is a drug control patch called Evra, and that's on a limited-use basis.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

From a federal perspective, what changes, if any, should be made to the CDR?

Any or all of you could respond to that.

[Verna Bruce]

There are questions that have been raised, probably by other partners, around transparency. For us, we're really glad there are a couple of client people sitting on the committee. In terms of other things from the partnership, again, we've been working with the results of the EKOS Research.

I don't know if I can add anything, but someone at the table may want to.

There are always things you can do to improve.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Do you think it's time for another in-depth review? It's a young group and it has been an evolving process, from what I'm hearing. Is it time now after four years to do another in-depth review?

[Verna Bruce]

I guess you'd have to talk to other people who are partners in the CDR.

From the Federal Healthcare Partnership perspective, it has been four years and it is working well. Part of me would hate to think of all the resources required from the health care system if we were going to do another review of something that's working relatively well for us. Maybe it's not working as well for the provinces and territories; I can't speak to that. We have a member sitting there, so it's meeting our particular need at this point in time.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Go ahead, Ms. Hoffman.

[Abby Hoffman]

Mr. Chair, if I may comment, I think there are a couple of things we might say about improvements. The first is about accelerating the further development of the CDR.

Earlier I mentioned the issue of class reviews. That would allow CDR to move from what it does now, which is to review new drugs, to actually doing some retrospective reviews of an entire array of drugs for a single condition. I think that would provide extremely useful information. That's a matter of building capacity in the CDR and permitting it to take that on, on behalf of all jurisdictions.

The other issue I think you'll undoubtedly hear about as other witnesses appear at this committee is the issue of drugs for relatively rare diseases. These are small populations where the drugs are extremely expensive. There has been criticism because using its normal analytical tools the CDR has tended to recommend against the listing of those drugs. That's an appropriate recommendation and advice that CDR is currently offering.

Whether governments ought to consider asking the CDR to open up a new stream of analytical capacity so that it could look at those drugs and provide a more nuanced recommendation about the circumstances under which some of those drugs ought to be reimbursed by public authorities, I think, is a very important question. I'm not going to prejudge what the answer is. It's that kind of sophistication and more complexity in what CDR could take on that I think would be of interest to this committee, and that is apropos of your question about further review or study of the CDR.

I think it would be more useful to look at new areas that the CDR could explore rather than once again going over the territory that I think CDR already quite capably undertakes.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Monsieur Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Mr. Chairman.

I'd like to thank the witnesses for joining us.

As you know, last week we met with industry officials as part of the review process. One sticking point seems to be the wait times under the program for recommending that certain pharmaceuticals be listed.

I listened closely to your opening remarks, Ms. Bruce, and I came to the conclusion that even if faster decisions were made on new listings under the program, your respective departments wouldn't be able to act any quicker on this and new drugs would not be available any faster.

Is my understanding of the situation correct?

[Verna Bruce]

That's one that I think we, and perhaps some of the other partners around the table, would need to think about. I know we only have a limited amount of capacity. If CDR were to all of a sudden really speed up, then we'd have to take a decision about trying to put more resources at the departmental level to evaluate that against our own drug plans.

I don't know if others have a view.