Certainly. First of all, I would just say that because the approval process is so complicated many companies do not want to come to Canada first. It takes too long. Quite frankly, it means then that, even for the drugs that come in, it's oftentimes months and sometimes years after they're brought into the other OECD countries, so that's the beginning.
We obviously have a multistep process. We have Health Canada, the regulatory process, which I must say has actually done a great deal to shorten the timelines. We then have to go to the Patented Medicine Prices Review Board, which provides guidance in terms of the cost, the maximum price of the drugs. It goes to the health technology assessment groups. Now in Canada, there are the drug agencies, CADTH and INESSS, which, again, adds months and sometimes longer than that to the process. The big challenge comes when, for the public drug plans, the drugs then go—if they're recommended by the technology assessment groups—to the pan-Canadian drug agency. There, they can actually take months and sometimes years.
We have drugs that have been sitting there for multiple years, even before they get picked up to be negotiated. They negotiate the price there. There is no timeline. There's no transparency. There's no input into the process, so there they can languish. Then even if they get a negotiated price, it is not necessary that every province lists these drugs, even though they signed on to say, yes, we will be part of it. Again, we have the problem that these drugs now, sometimes not just months but years later, are not even listed in the public drug plan. In some cases, they never get into the public drug plans. There's no way of making them be there.
This is the challenge, and we can say for patients, of course, it is a terrible problem, especially for these patients who are waiting for life-saving therapies. For rare diseases we oftentimes do not have another therapy. As I say, it's also a disincentive for companies to even bring the drugs to Canada, and we oftentimes have to really beg them to bring the drugs here because they know it is not only a long but also a very complicated process.