HESA Committee Report

ANALYSIS OF IMPLEMENTATION

NATIONAL PHARMACEUTICALS STRATEGY (NPS)

The NPS was one of many competing areas of focus within the Accord. While there has been criticism that the NPS has not progressed as quickly as some had expected, meaningful progress has been made on the priority elements of the NPS over the past four years.

Background

Pharmaceuticals play an increasingly important role in Canadians’ health and Canada's health care system. They save lives, prevent the spread of disease, improve quality of life, and control pain and suffering.  Their role is likely to grow in the future as technological advances result in new drug therapies that replace earlier treatment methods or provide new options where no treatment existed before.  Health Canada is working with provinces and territories to improve timely and affordable access to safe, effective, high-quality pharmaceuticals.

Federal regulation of the pharmaceutical sector focuses on three objectives: protecting the Canadian population against safety-related risks by determining whether a drug can be sold on the Canadian market; stimulating pharmaceutical innovation through the granting of patents while protecting consumers against excessive patented drug prices; and, providing drug benefits to federal populations. 

The federal government plays a leadership and funding role in helping to improve the efficiency of the system across federal and P/T governments. While drug coverage is a provincial and territorial responsibility and management may occur differently across jurisdictions (e.g., different fee schedules, reimbursement methods and coverage) collaboration across jurisdictions can help identify best practices, strengthen negotiating power with drug manufacturers, and, ultimately, lead to greater efficiency.

Federal drug plans, combined, represent the fifth largest payer among all public drug plans in Canada. (The six federal plans are managed by Health Canada, Veterans Affairs Canada, National Defence, the Royal Canadian Mounted Police, the Correctional Service of Canada, and Citizenship and Immigration Canada.) As such, the federal government benefits, in a similar manner to P/T jurisdictions, from improvements in such areas as drug assessments and pricing and purchasing strategies.

Federal Work

The federal government has devoted significant human and financial resources to joint leadership with British Columbia of the NPS itself and individual NPS element working groups. 

The federal government is contributing to many NPS elements through other mechanisms, such as Canada Health Infoway and the Canadian Optimal Prescribing and Utilization Service (COMPUS). Since it was created in 2001, Canada Health Infoway has received $1.6B in federal funding. Infoway’s mission is to foster and accelerate the development and adoption of electronic health information systems across the country that have compatible standards and technologies, building a necessary basis for further initiatives such as e-prescribing. Similarly, the federally-funded COMPUS is contributing to the appropriate prescribing and utilization element of the NPS through its products and services, as well as its linkages and partnerships with F/P/T governments and other stakeholders. COMPUS identifies and promotes evidence-based, clinical and cost-effectiveness information on optimal drug prescribing and use. 

Beyond the nine elements of the NPS, the federal government has undertaken other initiatives to improve pharmaceuticals management in areas of clear federal jurisdiction, i.e., the development of a product lifecycle approach to drug regulation; the review of the Special Access Program; and the updating of the Patented Medicine Prices Review Board's Excessive Price Guidelines.

Health Canada has also worked in conjunction with other federal departments to seek and provide necessary information related to the NPS.  For example, the federal Competition Bureau has been invited to discuss their assessment of the competitive environment for generic drugs at NPS working group meetings.

Provincial and Territorial Work

We are preparing for discussions with our provincial and territorial colleagues on our ongoing collaboration on pharmaceuticals management. This is an opportunity for us to define the next phase of the NPS, and the outcome of this dialogue is likely to guide our approach to collaborative work in other areas of shared interest in pharmaceuticals. 

Health Council of Canada comments

In its 2006 Annual Report to Canadians, the Health Council of Canada expressed its disappointment and criticized the slow progress in implementing the elements of the NPS.  In particular, it was disappointed at the slow progress toward catastrophic drug coverage.  It recommended that governments “proceed quickly” on meeting the commitment on catastrophic drug coverage, “a timeline for implementation should be established and communicated, and work should begin immediately on an implementation plan.”

The Health Council released a report on the prescribing behaviour of health professionals in October 2007 as a follow-up to its policy symposium in June 2007.  Though not directly about the NPS, this report is relevant given that enhanced prescribing behaviour was included as an element of the NPS, though not one of the five priority elements.