The challenge in terms of accessing drugs for rare disorders are many, as you say, and they vary in different countries. As we say, nobody has an ideal system.
When we look at New Zealand, let's be real clear. Nobody with a rare disease gets access. We know the New Zealand Organisation for Rare Disorders very well, and almost nobody gets access to any treatments. For his two children, the past president never got access to a drug that actually was quite readily available both in Australia and in Canada. If you want to use New Zealand as an example, it's absolutely not going to be supported in terms of rare diseases. Their formulary is very limited. New Zealand is just off the table in terms of any kind of comparison.
You can look at other countries. Obviously, there are some countries that do it better. Partly what we will recommend is looking at the countries that do it well.
How do we bring these in early on? How do we negotiate a price? Part of the challenge in terms of pricing in Canada, as you know, is that we do have a private market system that actually does not negotiate as one in the same way that the public system could. The difference in what we pay privately and what we pay publicly is huge.
Quite frankly, the reason we get such great prices publicly—and we know when we look at those prices that they are much lower than many other countries would get for those drugs—is that they can offset it with the private. If we're going to have a harmonized system, one system, then we're going to have to look at somewhat of a blended price. We agree.
We do agree that the prices can come down lower in Canada, and they should come down lower. We do not agree with what the regulatory reforms are suggesting, that is, that we put a value-added proposition up front to look at the list price. Again, this is not what other countries do. It will put us at a disadvantage.
We agree. Negotiate better in order to get a price that's actually going to bring us down, no doubt about it, but one of the ways to do that is to negotiate as a country, to negotiate as one drug plan. We believe that would be helpful. Also, definitely, bringing in the drugs earlier on and then negotiating those prices, the way Germany does, the way France does, the way the U.K. has been able to do, and where we've seen Australia going...these are some of the models. We think Canada could do quite well if it follows what it's doing but recognizes that the differential in pricing has to do with the fact that we do have a large private component.
That's a different question in terms of how we want to address this, and it's something that Dr. Hoskins is trying to address for pharmacare, but quite frankly that is not actually the situation with regard to public prices in terms of rare diseases. We negotiate pretty hard on those and we get them down pretty low. The problem is that it takes two to four years to negotiate them. There's where the tragedy lies. I think we can have a better process that can do it in a much shorter period of time if in fact we look at the negotiations at the time of the NOC, with the HTA having been done appropriately at that point.