The new PMPRB guidelines will affect prices to some degree in Canada, but it is important to recognize that if you bring down the list prices of medicines in Canada you may not have as dramatic an effect on the final net-of-rebate prices. For example, let's just pretend the list price of a medicine is $100 and the manufacturers and provincial drug plans have negotiated that a price of $70 is actually value for money, which is about right in terms of the average rebate that they negotiate on behalf of public health systems in Canada. Now, imagine that PMPRB regulations brings the list price down to $90, not $100, and the final price to the provinces is going to continue to be $70. The private insurance companies are going to save the $10 reduction in the list prices, but the net savings to Canadians in terms of the public programs is ultimately determined by price negotiation power.
The exception to that rule is with these very expensive drugs for drugs that treat very serious conditions. We've heard some examples with CF treatments, and there are other examples across the spectrum of needs of patients, where, because there are just one or two medicines that truly, effectively treat a given condition, the prices can be so high that there is no such thing as people paying cash or buying the medicine at the pharmacy. Pricing is entirely arrived at by negotiation between public plans and the buyers. It's in those negotiations where the PMPRB regulation has significant potential to prevent the systems that we have for our public health care from being abused in the sense of being held captive against really excessive price asks by manufacturers.
I'll just add—I know the chair has raised a yellow flag for the time allowed—that this is one of the reasons why countries around the world are paying close attention to what's happening here in Canada with these regulations. I think there are countries around the world.... I say this as a person who, for the last 15 years, has hosted an annual meeting of people responsible for pricing, regulation, and health technology assessment, in about a dozen high-income countries, and I know that the members of that group—known as the “Vancouver group” because I'm their host—have often reflected on these regulatory reforms that are under way in Canada. They see them as potentially valuable even in their systems.