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Thought leadership and innovation for the Pharmaceutical Industry

eyeforpharma talks to Russell Williams, President of Canada's Research-Based Pharmaceutical Companies on Rx&D’s role in advancing access for the Canadian patient.

By Deirdre Coleman on Apr 7, 2014

Despite the demonstrated benefits of new medicines and vaccines to improve health outcomes, Rx&D's 2011-2012 International Report on Access to Medicines finds that Canada's public drug plans continue to provide less access to new medicines and vaccines compared to 32 other developed nations. The focus of the research was aimed at answering a straightforward question: how does Canada’s access to innovative medicines compare to other countries? Shockingly, the report’s findings revealed that comparing access to innovative medicines in Canada with other OECD countries, Canada ranked 23^rd out of 32 countries.

Key findings include: 

• Canada continues to be near the bottom of the rankings for all categories; from a high of 21st place (out of 32 countries) for the non-Common Drug Review (CDR) and Joint Oncology Drug Review (JODR) medicines to a low of 27th place for the CDR reviewed drugs. This means Canada ranks in the fourth (4th) quartile for most drugs and ranks in the third (3rd) quartile for cancer drugs.
• Canada does not compare favourably on the reimbursement of medicines for a number of diseases. Public drug plans in Canada offer superior reimbursement to the average of other OECD nations in only two disease categories: arthritis and urology. In some disease categories, Canadians have access to medicines at a similar level to other nations:  addiction, gastrointestinal and HIV/AIDS.  However, Canada compares poorly to other countries in the areas of pain management and rare disorders.

Only half of the new medicines approved by Health Canada are made available to Canadians through public drug plans and as a result, Canadians do not benefit from the full range of new pharmaceutical innovations.

More and more, public drug plans in Canada are making new medicines available only on a conditional, case-by-case basis – resulting in more administration, wait times for patients before beginning treatment, increased paperwork for physicians; and most importantly, no guarantee that patients will receive coverage.

My role with Rx&D is to improve access for patients, by raising awareness and opening up dialogue with the various stakeholders and carrying out value demonstrating initiatives that show that a dollar invested in innovative medicines will ultimately save dollars elsewhere in the healthcare system.

According to Russell Williams, President of Canada's Research-Based Pharmaceutical Companies (Rx&D), “Canadians should have access to the innovative medicines and vaccines that will transform their lives and we know that proper and appropriate utilisation of innovative medicines will provide better outcomes and reduce costs to the healthcare system overall. My role with Rx&D is to improve access for patients, by raising awareness and opening up dialogue with the various stakeholders and carrying out value demonstrating initiatives that show that a dollar invested in innovative medicines will ultimately save dollars elsewhere in the healthcare system. With 40-50% of provincial budgets now being allocated to healthcare and that figure set to escalate in the next 25 years, the current situation is unsustainable. Canada’s healthcare system needs to transform into one that is highly productive and sustainable by leveraging innovation to support the redesign of health services toward managing chronic illness and supporting population health and wellness, particularly among the elderly”.

New Medicines, Better Health Outcomes

 Total direct spending on patented medicines accounted for $12.8 billion or only 6.2% of the $205.9 billion spent in total on all health care in 2012".

Canada is one of the top spenders per patient internationally when it comes to healthcare, spending an estimated $211 billion in 2013, according to the Canadian Institute of Health Information (CIHI). However, a study¹published by Canadian Health Policy Institute used data from CIHI and the Patented Medicine Prices Review Board to calculate that total direct spending on patented medicines accounted for $12.8 billion or only 6.2% of the $205.9 billion spent in total on all health care in 2012. It also calculated that total direct spending on patented medicines grew by only 4.1% from 2007 to 2012, while total spending on all other health care (excluding patented medicines) grew by 30.5%.

The CHPI study also showed that after adjusting for population growth patented drug costs are declining over time: per capita total spending on patented medicinesactually declined -1.8% from 2007 to 2012, while per capita total spending on all other health care (excluding patented medicines) grew by 23.2%. The study concluded thatthe very small percentage of total health spending or provincial/territorial government health spending accounted for by patented medicinesmeans even the most extreme cost-containment efforts will not return significant overall savings.

“Knowing the truth about drug costs is important. Policy decisions made on the basis of misinformation about the cost of patented drugs have the potential to negatively impact our current and future access to the best available treatments".

A 2013 study² published by the Conference Board of Canada examined the health and economic benefits associated with spending on pharmaceuticals in Ontario from 2007 to 2012. The study found that the added costs associated with the use of innovative pharmaceuticals were offset by reductions in the use of other types of healthcare resources and a reduction in the productivity losses associated with disease as a result of improved health outcomes. In particular, the $1.22 billion spent on six classes of pharmaceutical drugs in 2012 generated offsetting health and societal benefits of nearly $2.44 billion in the same year. Under a baseline projection of pharmaceutical demand over 2013–2030, all six classes of drugs examined in the study were expected to provide health and societal benefits in excess of the estimated costs of treatment, with the ratio of benefits to costs increasing over the longer term. The study also concluded that improving patient compliance with their medication regimens (i.e. adherence to therapy), would increase the overall health and societal benefits.

“Knowing the truth about drug costs is important. Policy decisions made on the basis of misinformation about the cost of patented drugs have the potential to negatively impact our current and future access to the best available treatments; to distort the efficient achievement of desired health outcomes by Canada’s health system. Rx&D invests heavily in value demonstrating initiatives, working closely with payers, government, healthcare providers and the academic community at research centres, to work on projects that demonstrate the value of innovative medicines to improve outcomes and reduce costs. A study by Columbia University found that every dollar invested in new medicines saved $7 (US) in other health-care costs by reducing hospitalization, surgery and physician visits.

Since 1994, Rx&D has distributed more than 6 million copies free of charge of a brochure and medication record book entitled Knowledge is the Best Medicine, which promotes healthy living and medication safety. This consumer awareness program is designed to promote healthy living and educate Canadians about the safe and appropriate use of medicines and vaccines. We have worked with 2,500 organizations throughout Canada - including doctors, pharmacists, hospitals, governments and patient groups. This initiative now also includes a free iPhone app – MyMedRec – which is a portable up to date health record that can be easily shared with the patient’s family, doctor, nurse, pharmacist or anyone else involved in their healthcare. It helps patients keep track of the medication they are taking, set dose reminders and record clinical outcomes such as blood pressure and cholesterol, promoting proper utilisation of medicines”, confirms Williams.

Collaboration

Advancing medical knowledge and improving health depend on regular information-sharing interactions between all partners. Stakeholder groups, whether they are patient groups, health charities, professional associations, academics or the business community, each work to meet the needs of their respective constituencies by providing information, education, and discussion of issues important to patients.

“We need to work together to achieve our collaborative goal: efficient and effective benefit programs that support healthy and productive citizens today and into the future. To this end, innovative medicines and vaccines are a proven and worthwhile investment. They are an economical solution to serious health system and economic prosperity challenges, not simply a cost to be contained. Part of this collaboration are ethical codes of practice to ensure ethical conduct, transparency and accountability. To this end, five global healthcare organizations have established a Consensus Framework for Ethical Collaboration to support partnerships that will aim to deliver greater patient benefits and support high quality patient care”, states Williams who served as chair of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) Code Compliance Network (CCN).

Derived from the individual codes of ethical practice and health policy positions of the five supporting international organizations, this framework is based on four overarching principles:

• putting patients first;
• supporting ethical research and innovation;
• ensuring independence and ethical conduct; and
• promoting transparency and accountability.

Advancing the Access Battle

Canada’s publicly funded medicare system is often a source of national pride. But uneven access to innovative medicines from province to province and in comparison with other industrialised countries causes significant concern. As a result, Canadians do not benefit from the full range of new pharmaceutical innovations.  Currently, a patchwork of different programs provides Canadians with coverage for drug expenses, depending on where they work or live or how old they are or what their illnesses are. This is an inequitable approach that does little to ensure patients are getting medications that are safe and appropriate.

With the ageing population and improved medical technologies that let more people survive events like heart attack and stroke, a steadily increasing number of Canadians will have long-term needs for innovative medicines and vaccines. All healthcare stakeholders have an interest in ensuring that plan members have optimal access to the best available treatments. Knowledge is indeed the best medicine when it comes to demonstrating improved outcomes and lower costs with proper utilisation of innovative medicines and vaccines –a critical component in advancing the ongoing battle to improve access for Canadian patients.

Sources: 1 CHPI (2013). The cost of patented drugs in Canada.Canadian Health Policy, November 24, 2013. Toronto: Canadian Health PolicyInstitute

2. Hermus G, Stonebridge C, Dinh T, Didic S, Theriault L (2013). Reducing the Health Care and Societal Costs of Disease: The Role of Pharmaceuticals. The Conference Board of Canada, July 2013.

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Russell Williams will be speaking at Patient Centricity Canada, June 17-18. For more information on his presentation, or to view the agenda, click here.

For more information on Rx&D, click here.