You've heard some of the discussions around coverage or evidence development. Germany brings in a drug, they negotiate a price, and then they get a year to actually demonstrate that they have the outcomes they've promised. France negotiates a price, they have a year in order to make that drug available, and they get a negotiated one, two, three, or five years to actually demonstrate the outcomes.
If you get the outcomes, you get to maintain the price. If you don't, you get to reduce the price. In theory, if you do better, you get to raise your price. I don't know if that has actually happened.
Right now, in terms of Belgium, the Netherlands, and Luxemburg, as I say, they are coming in with managed access programs. The Netherlands is a very good example. With Fabry disease, they brought in the program and monitored patients over a period of time. They then began to say that some of it was working and some of it was not working, and they said who were the patients for whom it might be working. The patient community had a heavy consultation role in trying to parse out that community to make some decisions on how it would work better.
If Canada were to work much more internationally in this realm, we could do so much better. We're a small country. As you say, the U.S. has a big population, and their conditions of access are a little different and they collaborate a bit differently in terms of which patients get access. I can tell you that some of the patients in the U.S. are getting very frightened, even with private insurance plans, because the private insurers basically are also starting to come up with differential schemes, and they don't know how to collaborate.
I was amazed at how many times people pointed to Canada and said, “You folks have a great model.” They said that we have the best potential for bringing in the very best program, based on some of the infrastructure we have and based on some of the monitoring we have. When we start to talk about pharmacare in Canada, people really do suggest that Canada could actually get it right. But we would have to do it internationally.