I have a couple of points. I'm glad you raised the issue around timeliness in terms of drug approvals and coverage decisions. Some of the evidence that's been cited in testimony in these hearings comes from reports that start the clock, so to speak, when a medicine is first approved in any country internationally. It doesn't take into account the fact that manufacturers themselves choose to delay the introduction of a drug into some markets for strategic purposes, but also often they'll trial drugs in markets like the United States, Germany or Japan and then choose whether ever to even launch in other markets. Nearly half of all drugs that are trialled in that way don't make it to other markets. That's important to know.
With regard to delays in approval times, I think there are concerns about making sure that Health Canada is adequately staffed and resourced to make its timelines. There are also concerns about the fact that the fragmented system we have right now, with CADTH and the pCPA and then the provincial decision-making that follows it, is one that does beget long delays in coverage decision-making. In fact, it is one of these processes where no means no in terms of the recommendations from the advisory bodies, but yes only means “maybe”, because provinces are not bound to complete the coverage equation.
A truly national program, managed by an agency such as the Canadian drug agency or something like that, which was given the budget to manage and the task of making sure there was timely access, would be a system that would make sure we don't have those kinds of delays. It should be reasonably independent, but it should be accountable for performance.