Evidence of meeting #11 for Health in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was data.
A recording is available from Parliament.
Conservative
The Chair Conservative Joy Smith
We could ask the clerk to get that documentation for you. I believe she has it, if that will help. The clerk will get that information for you, if that is helpful to you, Madame.
Bloc
Christiane Gagnon Bloc Québec, QC
I see.
Mr. Benoit, you stated that your organization, the Patented Medicine Prices Review Board, determines if the prices charged for medicines are fair and justified. Why then do we have the impression that increases in the price of pharmaceuticals are excessive? Moreover, these increases put a strain on the health care system, because substantial sums are invested in pharmaceutical pricing. Many patients find the price of their drugs too costly. Rarely do we hear the PMPRB explain to us that some medicines are too expensive.
How do you go about informing the public of the choices you make with respect to a particular drug?
Chairperson, Patented Medicine Prices Review Board
Thank you, Madam.
I can answer that question. First of all, the role of the PMPRB is to protect Canadian consumers from excessive prices. The meaning of the word “excessive” is poorly understood by the public because drug companies will tell you—as they no doubt did last time they appeared before you—that they spend a considerable amount of money on R&D. Our role, however, is to define the word “excessive” and we do that in several ways.
Firstly, our scientists analyse all of the clinical studies done on a drug. We ask them to identify therapeutic comparators, beginning with comparators in Canada, and if that is not possible, those in seven countries, for example the United States, Great Britain, France and so forth. We compare prices. A price is deemed excessive if it is much higher than the price of these comparators.
The public only looks at the excessive price. It thinks the price is high, but it may not be aware, however, that a particular drug is the only one that can treat a particular illness.
There are different categories of drugs. A drug that is the only available treatment for a particular illness would be a category 2 drug, meaning that its benefits are recognized as being much greater than those of its comparators. This fact justifies charging a much higher price for the drug.
Bloc
Christiane Gagnon Bloc Québec, QC
The perception exists—and the numbers bear this out—that pharmaceutical companies invest less in research and far too much in marketing. What is your opinion? You claim that they invest heavily in research? Others have observed that...
Chairperson, Patented Medicine Prices Review Board
I would not say they spend “heavily”, Madam.
Chairperson, Patented Medicine Prices Review Board
They do invest in research and each year, we do an analysis, since they are required to disclose how much money they have invested in their research efforts.
When Parliament created the PMPRB in 1987, it called on the pharmaceutical industry to invest 10% of its gross revenues in research. The industry may have achieved, or surpassed, the 10% target once or twice over the past twenty years. Last year—Barbara is feeding the information to me—pharmaceutical companies spent 8.5% of their gross revenues on research initiatives.
This figure excludes advertising geared to doctors and the like. It represents money that is invested in primary research and in clinical trials.
Bloc
Christiane Gagnon Bloc Québec, QC
Ms. Yeates, you stated that your organization plays a supporting role. How do you decide where to target your research efforts? You mentioned some of the areas on which CIHI focuses its research. Who tells you where you should be focusing your attention? After all, a number of organizations are interested in the side effects or effectiveness of drugs. Who provides you with the information and how to you go about getting additional information? For example, do you rely on MedEffect for information on the effectiveness of a particular drug?
President and Chief Executive Officer, Canadian Institute for Health Information
Perhaps I would be better off answering that question in English, given my French language skills. The subject matter is rather technical.
We have a number of advisory groups. We also speak to the drug plan managers across the country if they have concerns or issues in the management of their drug plans. That's one source. We also talk to other experts in the field.
We have a certain expertise, and there are many others, in university research settings, for example, who have different expertise. We try very hard not to duplicate the work they might be doing. We look for gaps in research that our data can answer, which is relevant and deemed important by experts in the field.
Conservative
The Chair Conservative Joy Smith
Madame Gagnon, I'm sorry, your time is up. It's over seven minutes. Thank you.
Mr. Tilson.
Conservative
David Tilson Conservative Dufferin—Caledon, ON
I'm one of the new boys here, so I'm not as informed as some of the other members. But as I understand the process, we're trying to determine how we can lessen the effects from drugs, either through human error or some defect in the drug that wasn't caught in the pre-examination.
As I also understand it, from what has been said by other witnesses and what you're saying, the only people who report to the Ministry of Health are pharmaceutical companies, although it's going to be suggested that hospitals report. Doctors don't and long-term-care people don't—the others who Doctor Bennett referred to.
You, Ms. Yeates, only look at human error. I think that's what you said. So there appears to be a problem.
Monsieur Benoit, your issue is that you have a general mandate and you can get into all kinds of things.
Because of that, I look to both of you, through your experience and what you're doing, for recommendations to the Government of Canada as to how the process could be improved.
We'll start off with you, Monsieur Benoit.
Chairperson, Patented Medicine Prices Review Board
First of all, the PMPRB's role in reporting has primarily a financial impact implication. Our interest in collecting or using a lot of the CIHI data is to analyze it so that we can help the public drug plans better manage their operations. We tell them what's coming in the future—
Conservative
David Tilson Conservative Dufferin—Caledon, ON
Okay. I don't know whether you philosophize as to your recommendations—
Chairperson, Patented Medicine Prices Review Board
I'm just trying to say that our particular mandate at the moment is primarily financial. If we were to take on something like the mandatory reporting of adverse events, we would have to create a different structure.
I'm also a practising physician, so I know many—or most, I would say—adverse reactions don't ever get reported. Most of them, fortunately, are relatively minor, and the only ones that will eventually come to—
Conservative
David Tilson Conservative Dufferin—Caledon, ON
As I understand it, Dr. Benoit, from previous witnesses, the only things that are reported are serious adverse reactions.
February 7th, 2008 / 11:45 a.m.
Chairperson, Patented Medicine Prices Review Board
That's exactly what I've just said. Most of the minor adverse reactions are not reported. If this committee is to make a recommendation—I'm going to speak for our particular organization—we would like to know what your objective is, and then we could say how we would fit into that objective, because at the moment, adverse reaction is not part of our business.
President and Chief Executive Officer, Canadian Institute for Health Information
Thank you for the question.
I should maybe be clear: we are not a federal body, we are not a regulatory body, and we are non-profit—
Conservative
David Tilson Conservative Dufferin—Caledon, ON
I understand that. It's just that both of you are aware of the problem—
President and Chief Executive Officer, Canadian Institute for Health Information
Yes.
Conservative
David Tilson Conservative Dufferin—Caledon, ON
—and it's in that capacity that I'm asking you to offer your suggestions.
President and Chief Executive Officer, Canadian Institute for Health Information
Our expertise is in collecting and building databases. If it was desired that we build a database that would collect this and there were mechanisms put in place to have people submit that data to us, I think we would be very happy and able to do that. If it were thought that a body with regulatory power, such as Health Canada, would be the appropriate place to actually do the regulation and the data were to be submitted directly to them, I could certainly understand that model as well.
I was previously a deputy minister of health in a province, and I do certainly appreciate that this is a very real challenge for the country. To have a place where people can submit this data and have it clear that there is the capacity to both build a system to manage that but also to build the expectation in the system is no small undertaking, but I think it is one that is laudable, and certainly there are different potential avenues to do that. Clearly the regulatory framework would have to be such that the agency had the power and the ability to do that and they would be of some interest in the country.
Conservative
David Tilson Conservative Dufferin—Caledon, ON
With respect to reporting--I lost some notes here, so I'll have to wing it--the witnesses we had last session talked about harmonization with the United States and the European Union because of the number of drugs that go there, or indeed come here. What are your thoughts on that, and could you comment as to how that would take place?