Health committee  Can I answer the last one? Basically, our objection is to the process. We have never, and will never, advocate for a specific drug. We have never asked CDR to re-examine drugs they've made a recommendation on, but over the last year and a half we have used the one drug that is recommended in our clinical practice guidelines to have some of the discussions around surrogate markers and all these other issues.

Health committee  All of the drugs that have been reviewed by the common drug review were approved by Health Canada as being safe and effective, upon their reading of the scientific and clinical evidence. Because the Patented Medicine Prices Review Board is responsible for ensuring that Canadians don't pay more than they should for their medications, the median price of seven countries is selected as the maximum price point for a company to sell that drug in Canada.

Health committee  Before the CDR, there were three steps. There was Health Canada, the Patented Medicines Prices Review Board, and then it went out to the provinces. Now we have Health Canada reviews for safety and efficacy, Patented Medicines Prices Review Board reviews for the price, and the CDR reviews both of their studies and brings in some additional studies from the pharmaceutical industry or a manufacturer of the drug, we think, and then they make their recommendation.

Health committee  Yes. There have been four diabetes-related drugs reviewed by the common drug review. All four have been recommended, no listing. Fortunately, or unfortunately, Ontario and Veterans Affairs Canada have been proactive and actually listed all of these drugs anyway. There may be a bit more paperwork, because they don't necessarily list them openly.

Health committee  That's right. They're conditionally listed on the Ontario formulary. Other provinces are still reviewing them as well, like Alberta, Manitoba, and P.E.I. These drugs go through another review process after they leave CDR, and they don't necessarily listen to the CDR recommendation at all.

Health committee  The common drug review is where federal, provincial, and territorial drug plan managers sit at the table, but the recommendation they make is to the provinces on the participating plans. They actually decide what to put on the formulary according to the plans. They look at the impact on the provincial budgets.

Health committee  Right now the Canadian Diabetes Association issues world-class clinical practice guidelines for the prevention and management of diabetes in Canada every five years. Those guidelines go out to every single practising physician in Canada. The problem is often that the physicians are very busy or they know their patients have low incomes and can't necessarily afford the drugs they might want to have.

Health committee  Yes. The answer is yes.

Health committee  They don't have an alternative, but they come to us and ask for our help. We train them to be advocates and send them to your office.

Health committee  Insulin glargine, which is also known as Lantus, is recommended in our clinical practice guidelines, which are developed by our professional volunteers. In 2003 they recommended that for nocturnal hypoglycemic patients who suffer from going into comas at night, their physician should consider putting them on insulin glargine as a third line.

Health committee  The health professionals. It's all based on the science. This is what the published peer-reviewed clinical trials and research showed. If you have trouble with going into lows while you're asleep, then your physician should seriously look at using insulin glargine as a way to keep you stable.

Health committee  Yes. What could happen is that, for instance, it could be under special authority; that's what they do in Australia. Your physician makes the case that other treatments haven't been successful for you, so it might be a second- or third-line treatment. You could then apply to be part of this research program; you'd have to agree to be part of it.

Health committee  I think you might find it such a big review that you would never get through it in the time you have allotted for it. That would be my concern. It's a slightly separate issue, relating more to the innovation side of the question, and I would keep the common drug review focused on processes and on trying to streamline them so they're more effective.

Health committee  The conditional listing idea is Australian. Australia operates it, and they have a similar government structure to ours. So I think we could look at them in more detail and adapt it for the Canadian situation. We think there are a lot of stakeholders at the table right now who aren't communicating through the common drug review process.

Health committee  We think the catastrophic drug plan...that's our ask, actually. There needs to be a national catastrophic plan that ensures that no Canadian pays more than 3% of their annual income on prescribed medications, devices, and supplies. Because the common drug review isn't working, we're arguing that any drug approved by Health Canada and given the opportunity to be sold in Canada through the Patented Medicine Prices Review Board should be covered.