Thank you for the question.
Remember that pricing is partly under the control of the Patented Medicine Prices Review Board, which has been a pussycat throughout its history. To the best of my knowledge, it has never exerted any serious attempt to control drug prices in Canada.
CADTH, so far as I know, was modelled originally on our process in British Columbia; however, it repeated one of the mistakes the British Columbia government made in 1994-95, which was to guarantee secrecy to the pharmaceutical industry sponsors on the grounds of protecting commercial or trade secrets. A detailed report that I produced, for example, on donepezil—the brand name is Aricept—was never released to the public because the British Columbia ministry had agreed with Pfizer not to release it.
On the common drug review, I'd like to give you an example. I was invited to participate in the review of two drugs, but I'm not allowed to tell you which, so I'm not going to. However, the drugs reviewed were pregabalin—brand name Lyrica—for pain, and a form of fentanyl that can be taken under the tongue or in the mouth.
As a condition of that work I was paid $10,000, through a contract with UBC; I was obliged to sign a confidentiality agreement that I would not disclose anything I learned to anybody, including the people of Canada; and I was approved by UBC and its ethics committee, which is an outrage, I think. I'm very impressed that a meeting like this is available to all the people of Canada in both languages.
What I learned as part of that procedure that I'm not telling you is that pregabalin was less effective than an old drug, amitriptyline, for neuropathic pain, pain in the feet of people with diabetes, and barely better than a placebo. To its credit, the common drug review did not recommend that this drug be listed on provincial formularies. Who paid, however, for all of the work that went into that honest academic assessment of the drug? Why did the studies that the company did not publish remain secret? That's what needs to be fixed with the common drug review.