Health committee  To my knowledge, none.

Health committee  The change from the 10% commitment in 1986—and we had to dig up the agreement letter with the federal government on it—

Health committee  —was defined in a specific way so that the terms and conditions and the business practices would remain substantially the same. What has occurred over time is that drug development has evolved dramatically. It's much more international than it used to be and much more focused on international clinical trials.

Health committee  So it's an understatement of what's going on, really based on what has changed in drug development over time.

Health committee  Correct, and it's significant.

Health committee  Gaps can come in two forms. One can be a financial gap that you have to bridge. Ontario Trillium is an example of where you have to absorb a certain amount of out-of-pocket expenditure of your family income before you have coverage. The second gap, going back to my previous answer, is which drugs might be eligible for that gap.

Health committee  It's a great question.

Health committee  There was a study done in 1999, I believe, that identified that approximately 20% of Canadians were uninsured or underinsured, and it really hasn't been refreshed— although that number has come to have a life of its own. I'll use Alberta as an example, which is a province I know very well, having been the former drug plan manager there years ago.

Health committee  It is fair to say that the timelines are getting longer, on average. I will quickly go through why. The first step, prior to getting, or even seeking, public reimbursement—or, for that matter, private reimbursement—is that you have to go through the Health Canada process to get your market authorization to sell.

Health committee  Some private plans do some processes, many do not. For example, in many of the union plans, it's written that if there's a notice of compliance, in other words if the drug is available for sale, and there is a price, it usually gets added within about 100 days.

Health committee  One of the challenges is that we struggle with “pharmacare” as a term. We hear it a lot, but it's sort of seeking a definition. It could mean making having a very all-encompassing program making many products available for coverage, or it could be highly restrictive. If it gets highly restrictive and it's very difficult to make drugs available, I wouldn't say that the drugs wouldn't necessarily get filed to come to Canada.

Health committee  Okay.

Health committee  First of all, the way in which they measured or made the statement about research and development funding is on a very historical basis, going back to 1986 on the definition of what would be considered research and development costs. The evolution of drug development has changed dramatically.

Health committee  Oh, yes, and on the statement that Canada has the second-highest prices, the PMPRB shows that this is actually not true. In fact, depending on how you want to measure it, for the comparator eight countries for the PMPRB—this is the government's own agency that watchdogs this—we are number three or number four, depending on what measure you want to use.

Health committee  One of the major developments that have occurred over time—and it is both important and costly—is that the science is getting better. We are getting much better at understanding how diseases work, how illness conditions work, etc. However, that means that the folks whom we would be developing drugs to treat are more complicated and that we have to design our trials in ways that are very different from those in the past.