There are a lot of practical problems. For example, with some cancer drugs, each province has specialized cancer protocols it puts in place. In British Columbia, there's the British Columbia Cancer Agency. In Ontario, it's Cancer Care Ontario. Down in the eastern provinces it's a bit different. If a national formulary is intended to be mandatory—thou shalt follow whatever is here—that's going to cause a lot of disruption in the sense that, for some of these highly specialized technologies, people will have to change their protocols and the way they administer care. If, on the other hand, it's simply a reference guide, well, it's not going to cost a whole lot. It's fairly easy to put forward. We can list all the drugs that people have in common and the way they're funded.
I'll add another example. In Ontario the exceptional access program is used to stay on top of drugs that are highly specialized for multiple sclerosis, pulmonary hypertension, and a variety of other conditions, to make sure the province can track patients as they progress. That's how Ontario does it. Multiple sclerosis in Nova Scotia goes through a clinic at Dalhousie. They do it differently.
Will a national formulary force everybody to do it the same way, or will those decisions on who gets what drug be made in Ottawa? I think it would be significant. Those are where the costs would be. If it's simply a reference guide that these are the drugs that should be reimbursed, and the provinces still decide, then it will be fairly inexpensive. It might be informative to the extent that it identifies where there are some discrepancies across the jurisdictions.