Thank you for the question.
A have a couple of observations. The first is that you're absolutely right. It's not government that's writing prescriptions for patients primarily in our country; it's doctors. As I'm sure the committee can appreciate, the decision to pick up one's pen and write that prescription is the culmination of a whole lot of complex factors.
What do we know works with respect to improving the appropriateness of prescribing? There's no single silver bullet.
What you want is a system in which, first of all, you can provide the best possible guidance based on evidence. We know that having an evidence-based formulary does work. Physicians are going to write prescriptions by and large for drugs that are covered for our patients. Patients are going to demand that we write prescriptions for the drugs that are covered for them. The use of an evidence-based formulary.... There are examples of formularies even in Canada that are tiered so you know that if your patient has failed the first-line therapy, for example, then you can move to the next therapy, which is more expensive, etc. Using the formulary to shape prescribing is an important way that governments—whether at the provincial level or at the pan-Canadian level, or because we collectively decide to hand those decisions over to an arm's-length agency—can shape prescribing among providers.