We get a lot of people who suggest that we should adopt something like Quebec did because they've got a very good patient d'exception program, so that if the drug comes in before it has gone through all the full review, you can have an individual patient that's adjudicated.
I mean that's kind of okay and it's kind of not okay, because sometimes we get stuck there as well. Patients are getting on one at a time. We don't develop the registry. We don't get good formularies. In some respects I think what we want to do is to bring the other programs up to being able to provide.
If you think about the adapted pathways and about what's happening in terms of collaborative HDA, at the time the drug is actually approved, we should be able to know, especially for rare disease drugs, which patient should be on it or not. We're not going to get better evidence after HDA looks at it. We will get better evidence after it has been on the market for a while, and then we'll have some other reviews.
We believe, and what we've seen happening in Europe under things like ADAPT SMART, is that there is a review ongoing while it's under review by Health Canada. At the time of approval, we can already begin to make some decisions about who should get access, who should not, and what conditions to continue to monitor.
The Quebec program works because patients can jump into it. We do not necessarily believe that that has the longest term benefit in terms of having a reasonable access for everybody.