Mr. Chair, welcome back; and thank you to all the witnesses for the excellent testimony.
Dr. Coyle, I want to start with you. This committee spent the better part of two years looking at universal, public, single-payer pharmacare. That was our recommendation. One of the central issues in constructing such a system would be the formulary and how it would be constructed.
Some of the difficulties of that are who makes the decision about what drugs ultimately get listed in a formulary. There are pros and cons of everything, but in my view, you don't want politicians making the determination about what gets covered, because that subjects politicians to pressure that may or may not be appropriate. You don't want industry to be unduly pressuring to make listing decisions.
In my mind, I came to the conclusion that what you really want is an independent evidence-based panel of experts, broadly speaking, who are making listing decisions based on efficacy and value for dollar.
That gets to the nub of the question. When you have a drug that costs, say, $500,000 a year and has a very small population that may benefit from it and the efficacy is unknown or perhaps marginal, yet that drug is very critically important to that small patient group who may have little other hope or few other options, how do we make those determinations?