One example is Trintellix, which is an SSRI antidepressant. It came to the market and CADTH, at the time, basically did the evaluation. There was no clinical evidence that this new drug was bringing anything more as compared to existing drugs. The recommendation was to not pay a penny more for this drug than the lowest-priced drug of this category. Trintellix still entered the market with a price 10 times what it was for other drugs in the same category.
I was reading an annual report from the company Lundbeck that said that in Canada, Trintellix—this drug that doesn't have any clinical evidence that shows any advantage as compared to other drugs—managed to capture 24% of the antidepressant market in Canada.
In terms of rip-off, if we have a system that says that you can make a commercial blockbuster with a drug that doesn't bring anything new, basically the message we're sending, in terms of incentives for innovation, is don't innovate. We have a crappy system that will take in anything at any price. In terms of institutional rip-off, this is what is missing in terms of getting value for money.