It is 17 million.
Evidence of meeting #51 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was system.
A recording is available from Parliament.
Evidence of meeting #51 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was system.
A recording is available from Parliament.
12:30 p.m.
Senior Policy Advisor on Pricing and Reimbursement of Pharmaceuticals, Department of Pharmaceutical Affairs and Medical Technology, Dutch Ministry of Health, Welfare and Sports
It is 17 million.
12:30 p.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
It's 17 million. Okay.
You've talked about the fact that there are flat rate premiums, that there are small deductibles, and that there is also taxation associated with being able to provide a universal pharmaceutical program. What is the income tax amount that individuals are paying?
12:30 p.m.
Senior Policy Advisor on Pricing and Reimbursement of Pharmaceuticals, Department of Pharmaceutical Affairs and Medical Technology, Dutch Ministry of Health, Welfare and Sports
Do you mean in the Netherlands?
12:30 p.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
The flat rate premium is equivalent to $574 Canadian dollars, if I understand correctly. On top of that, individuals are paying a small deductible, and then on top of that, they're paying out of their income tax.
What is the amount of income tax that is going toward this program?
12:30 p.m.
Senior Policy Advisor on Pricing and Reimbursement of Pharmaceuticals, Department of Pharmaceutical Affairs and Medical Technology, Dutch Ministry of Health, Welfare and Sports
The Dutch system is a bit different. There is a nominal premium that the insured pay towards their health insurance. I've counted it, and it depends a little bit on the insurance company, but I think it's about 110 euro per month. This is the monthly nominal fee that the insured pay to their insurance company. On top of that, for those with lower income, there is a subsidy based on their average income.
In the back end of the system, there are some tax funds that go into this system, but they're not directly derived from the actual insured person.
Basically, everyone pays 110 euro, and they have a maximum copayment of $574 Canadian dollars per year, you can say, if they take health care.
12:35 p.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Sorry, with all due respect, that income tax dollar does come directly from the benefactor; hence, it's income tax.
What is the amount, then, that the government is putting toward this program? What is the annual expenditure?
12:35 p.m.
Senior Policy Advisor on Pricing and Reimbursement of Pharmaceuticals, Department of Pharmaceutical Affairs and Medical Technology, Dutch Ministry of Health, Welfare and Sports
I don't have right here the actual expenditure figure towards health insurance. It's not actually the pharmaceutical program that is specifically funded. It's a general funding of the national health insurance scheme that's being funded.
However, I can get that figure if you want it.
12:35 p.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Yes, that would be helpful. Thank you.
I'll now come to Ms. Wallström.
Do you know what the cost is? What cost is the government fronting in order to follow through on this program?
12:35 p.m.
Director General, Dental and Pharmaceutical Benefits Agency
For the outpatients pharmaceutical benefits scheme?
12:35 p.m.
Director General, Dental and Pharmaceutical Benefits Agency
That would be about 25 billion Swedish krona per year, which I think is about 2.5 billion euro per year.
12:35 p.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Okay, so it's 2.5 billion euro.
What is the population of your country?
12:35 p.m.
Director General, Dental and Pharmaceutical Benefits Agency
It is 10 million.
12:35 p.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
It is 10 million. All right.
I'm sorry, I don't know enough about the history. At what point did you move from whatever your former system was into a more universal pharmacare program, or has it always been?
12:35 p.m.
Director General, Dental and Pharmaceutical Benefits Agency
It has been so for quite some time. My agency was formed in 2002. Even before that, we had a universal pharmacare program in Sweden, but not with this kind of elaborated pricing and reimbursement decisions. It was more of an automatic reimbursement when new products came to market. Of course, in the seventies and the eighties that functioned pretty well, but in the nineties there was a financial crisis in Sweden. Several of the systems were re-regulated, and more cost control aspects were built into these systems.
12:35 p.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Thank you.
Can you explain to me a little bit about how you go about approving new drugs for market? Who approves the new drugs that come into the formulary?
12:35 p.m.
Director General, Dental and Pharmaceutical Benefits Agency
The regulatory work in Europe is harmonized, so it's the same for all the EU countries. There is a European agency, the EMA, that approves the drugs. That is a joint regulation for all countries.
12:35 p.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Sorry, I should clarify. I meant with regard to the formulary, in other words, the drugs you would cover under the plan.
12:35 p.m.
Director General, Dental and Pharmaceutical Benefits Agency
Of course. When the product has come to market, it is the TLV that decides the price and the reimbursement within the pharmaceutical benefits scheme. If it's an in-patient drug, it is the 21 county councils that have a tender procedure to decide on the price and usage of in-patient drugs.
12:35 p.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
Perfect. Thank you very much.
Mr. Golja, I would ask you the same question.
Can you help me understand how you decide which drugs are going to be a part of the formulary and which drugs are going to be covered for patients?
12:35 p.m.
Senior Policy Advisor on Pricing and Reimbursement of Pharmaceuticals, Department of Pharmaceutical Affairs and Medical Technology, Dutch Ministry of Health, Welfare and Sports
The National Health Care Institute of the Netherlands is more or less a scientific body that does the health technology assessment. It basically advises the minister on adding certain drugs to the formulary and the reimbursement. They assess the drug. They also do a cost-effective analysis based on the price the company provides, and they advise the minister on that. In the end, the minister decides what the maximum reimbursement will be for out-patient drugs.
