Thank you, Mr. Chairman.
First of all, thank you for inviting us here today. We appreciate it. I would also like to take the opportunity to introduce Karen Philp, our vice-president of public policy.
The Canadian Diabetes Association asks for your assistance. Today, the common drug review isn't working for Canadians with diabetes. We believe that with your support, we can make it work better or all Canadians, and we offer you our recommendations for your consideration during your critical study of prescription drugs.
Why is getting the CDR right important to Canadians with diabetes? First of all, there are more than two million people living with diabetes who need a mix of anywhere from five to eight prescription drugs in order to manage their diabetes effectively and to avoid heart attacks, stroke, kidney failure, and blindness. Being able to get the drugs prescribed by their doctors is the single biggest challenge identified by Canadians with diabetes in our survey undertaken for our Diabetes Report 2005, which I believe you all have.
Diabetes, as you know, is a progressive disease, and the longer you live with it, the harder it is for you to manage it. Canadians with type 1 diabetes need insulin daily or they die. Canadians with type 2 diabetes are often initially prescribed lifestyle changes before their doctors recommend oral medications and/or insulin as well as drugs for the prevention of complications, such as medications for lowering blood pressure and cholesterol and kidney-protecting drugs. After a few years, most Canadians with diabetes learn to self-manage their disease with a cocktail of between five and eight prescription drugs each day. In consultation with their health teams, they evaluate the effectiveness of their disease management on a regular basis.
Diabetes is responsible for 10% of all admissions to acute care hospitals. Yet research shows that if Canadians are able to manage their diabetes effectively with medications prescribed by their doctors, they may avoid the serious complications. This, Mr. Chairman, would free up more than 280,000 hospital beds each year for other Canadians waiting for surgery or acute care. By helping Canadians manage their diabetes effectively, all Canadians will benefit. By reducing the rates of serious complications related to diabetes, health care resources can be invested in better health care for all of us.
Recent research illustrated that for every dollar invested up front in managing diabetes, the B.C. government saved four dollars a year by not having to have complications treated in other parts of their health care system.
Over 70% of Canadians believe that the long-term savings from helping Canadians manage their diabetes effectively justifies government paying the cost of diabetes medications, devices, and supplies.
We all know that Canada has a unique heritage as a world leader in diabetes research that began with the discovery of insulin by Dr. Banting and Dr. Best. Canada continues to lead the world in diabetes research and innovation, whether it's through the islet cell transplants in Edmonton or the $25 million DREAM international clinical trial for the prevention of type 2 diabetes, led by McMaster University researchers. The Canadian Diabetes Association believes that Canada's leading role in diabetes research may be undermined if the CDR continues working as it currently does.
Finally, the common drug review is the foundation for a national pharmaceutical strategy as well as for a national catastrophic drug plan. Therefore, we believe the common drug review must have clear processes in place, be accountable, and be more transparent in order to give all Canadians greater confidence in its role in pharmaceutical policy-making.
All Canadians may need to access prescription drugs at some point in their lives, but Canadians living with chronic diseases like diabetes need them daily to live healthy and productive lives.
Our association welcomed the introduction of the common drug review in 2002. However, in our view, the common drug review has not, and is not, meeting its promise in 2007. To put it bluntly, the CDR is not working for Canadians living with diabetes.
Our association reviewed all CDR recommendations relating to four diabetes medications. All four medications the CDR recommended as not to list, yet all four of these drugs have been listed by at least one participating drug plan in Canada and are being provided on an open listing in at least four other countries.
After review, we concluded that there are serious flaws in the CDR drug review process. These flaws include unnecessary duplication and delays. All participating drug plans continue to review or even enhance their drug review process. Another flaw is too much of a focus on costs and not enough on helping drug plans establish a place in therapy for medication. It's irresponsible for the CDR just to say no.
Finally, CDR lacks transparency and accountability. We outline in detail in our written submission our concern about this, but in particular, the lack of independent appeal process is simply unacceptable.
Having said all this, we also propose a way forward for you to consider. Our association proposes that the health standing committee recommend that the Minister of Health appoint an independent panel to review the original mandate of the common drug review in relation to the roles of Health Canada, the Patented Medicine Prices Review Board, and provincial and territorial drug review processes.
Our association also asks you to recommend that the health minister create a new conditional listing for drugs approved by Health Canada as safe and effective. This new listing could be for anywhere between three to five years, while government and industry—and we believe industry must be involved in the design if we are asking them to pay the cost of the research—as well as health organizations undertake a research program that identifies the real-world economic costs and health benefits of a new drug. Governments would then make a final decision once the research results were known and published.
Finally, we ask you to recommend the immediate implementation of a number of steps while the independent panel undertakes its review and makes its recommendations. First, introduce greater transparency while maintaining a rigorous, objective drug review process by requiring CDR to cite all publicly available clinical studies and research used in their listing recommendation; release the criteria used to evaluate the cost-effectiveness of a medication; enter in discussions with CIHR on investing in research in Canadian universities to generate the much-needed economic and cost-effectiveness data; invite all interested parties to provide CDR with recommendations of qualified reviewers for their consideration in the selection of their reviewers of the scientific and clinical evidence for each drug; publish an annual list of these individuals contracted to review the scientific literature after a listing recommendation has been made public; and finally, introduce an independent appeal process that does not include individuals who have the initial recommendation for listing.
Mr. Chairman, we get the opportunity of travelling this country from coast to coast several times a year, and I won't give you all of the sayings or the requests by many of our stakeholders, but Mr. Ron Whipple, who lives in Fredericton, New Brunswick, made a comment that I thought is relevant to this committee. He stated very clearly that he would like to die with his diabetes and not because of it.
Thank you very much.