A Roadmap to a Rational Pharmacare Policy in Canada
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1 A Roadmap to a Rational Pharmacare Policy in Canada Canadian Agency for Drugs and Technology of Health 25 th Anniversary Lecture Series October 29, 2014 By Marc André Gagnon*, PhD Assistant Professor, School of Public Policy and Administration (Carleton University) All images are taken from freeimages.com
2 Conflict of Interest/Disclaimer Presenter: Marc André Gagnon, PhD Relationships with commercial interests: NONE Others: Research included in this presentation has received funding from the following organizations: Canadian Institutes for Health Research Canadian Federation of Nurses Unions Faculty of Public Affairs, Carleton University Ordre des Pharmaciens du Québec Canadian Health Coalition
3 OUTLINE 1. The Canadian system for drug coverage; Inefficient, inequitable, unsustainable 2. Recent Development in a Fragmented System 3. Collective Cost of Private Insurance 4. Rethinking Industrial Policy in Canada 5. Roadmap to a Rational Pharmacare Policy 6. Cost and Benefits of Implementing a National Drug Plan
4 Pharmacare for Canada? 1964: Hall Commission recommended Universal drug coverage for Canada : National Health Forum, under Jean Chrétien, recommended full first dollar coverage for all Canadians. 2002: Romanow Commission recommended universal catastrophic drug coverage as a first step towards universal pharmacare : The National Pharmaceuticals Strategy fails to achieve even catastrophic drug coverage for all Canadians.
5 1100 Total expenditure per capita on prescription drugs, 2012 or nearest year US$, purchasing power parity Source: CIHI, OECD Health Statistics
6 Percentage of the population covered by a public drug insurance plan in all OECD countries (%), 2010 (e): OECD estimate Source: OECD Health Data: Social Protection
7 Growth per capita for prescription drug costs, from 2000 to 2012 (international comparison based on PPP; 2000=100) Canada
8 Growth per capita for prescription drug costs, from 2000 to 2012 (international comparison based on PPP; 2000=100) Canada Germany
9 Growth per capita for prescription drug costs, from 2000 to 2012 (international comparison based on PPP; 2000=100) Canada Germany Australia
10 Growth per capita for prescription drug costs, from 2000 to 2012 (international comparison based on PPP; 2000=100) Canada Germany Australia France
11 Growth per capita for prescription drug costs, from 2000 to 2012 (international comparison based on PPP; 2000=100) Canada Germany Australia France United Kingdom
12 Growth per capita for prescription drug costs, from 2000 to 2012 (international comparison based on PPP; 2000=100) Canada Germany Australia France United Kingdom Denmark
13 Growth per capita for prescription drug costs, from 2000 to 2012 (international comparison based on PPP; 2000=100) Canada Germany Australia Finland Netherlands Switzerland Austria Spain France Sweden United Kingdom New Zealand Portugal Norway Denmark 120 Italy
14 Growth per capita for prescription drug costs, from 2000 to 2012 (international comparison based on PPP; 2000=100) Canada United States Germany Australia Finland Netherlands Switzerland Austria Spain France Sweden United Kingdom New Zealand Portugal Norway Denmark 120 Italy
15 What if Canadian per capita costs had evolved as in comparable countries? Country per capita cost difference (2000=100) Lost savings for Canada $ Canada United States billion Germany billion Australia United States: $1.3 G 2.7 billion France/UK billion New Zealand billion Denmark billion
16 Recent development in a fragmented system
17 1 Decrease in the price of generics
18 Comparison between the price of the five generic drugs sold the most in Ontario and the price of the same drugs in the United States and New Zealand, in cents ( ), Ramipril (10 mg) Metformin (500 mg) Citalopram (20 mg) Simvastatin (20 mg) Paroxetine (20 mg) Ontario United States New Zealand Source: Law, 2013
19 Average subsidy for Simvastatin 40mg Tablet, New Zealand Source: Pharmac
20 Average subsidy for Omeprazole 20mg Capsule, New Zealand Source: Pharmac
21 2 Product Listing Agreements
22 3 Pan Canadian Pharmaceutical Alliance (PCPA)
23 4 Drug Shortages
24 Collective Cost of Private Insurance (Institutional) Skimming Waste ($5.1 bn) Tax subsidies ($1.2 bn) Administration costs ($1.3 bn) Private Coverage of Public Employees ($3 bn?)
25 Rethinking Industrial Policy in Canada
26 If US and Germany were excluded, average median foreign Canadian price ratio would be 87% instead of 1.06%.
27 IP for R&D A brief success: Evolution of the R&D to sales ratio in Canada Rx&D patentees All patentees Source: PMPRB annual reports
28 120 R&D to sales ratio in Source: PMPRB, EFPIA
29 Evolution of revenues and R&D in Canada for All Patentees Revenues R&D Expenditures Source: PMPRB annual reports
30 Canada and Patented Drugs, 2013: Since 1988, Canada has offered generous prices to attract R&D investments. If price levels for patented drugs in Canada were similar to France or the UK, Canadians would save around $2.9 billion on patented drugs each year. Total R&D investment in Canada was $753 M in 2013 half of which was recouped through tax credits. The PMPRB regulation system makes Canadians pay artificially inflated prices by around $2.9 billions in order to generate around $380 millions in net R&D expenditures.
31 Understanding the business model we are fostering Does the current system provide the right financial incentives for drug companies to develop new treatments and improve health outcomes?
32 3000 Average real profits of US dominant pharmaceutical firms as compared to average real profit of Fortune 500 firms ( , in millions of constant 1984 US$) Average Real Profits for Big Pharma (US) Average Real Profits for all Fortune 500 firms (US) Source: Fortune
33 25 Average net returns on revenues (%) of dominant pharmaceuticals firms as compared to dominant firms in other industrial sectors. US, Average ROR in all Fortune Average ROR in the dominant pharmaceutical sector Source : Fortune
34 Shape of things to come? Valeant s Operating Principles (from the 2013 Annual Report): 3. Maintain a bias toward durable products that are largely cash pay, or are reimbursed through private insurance. [ ] Over 75% of our product sales are also cash pay or reimbursed through private insurance, helping to protect us from government driven price decreases that are becoming increasingly common around the world. We expect to continue our focus on durable products in less price sensitive markets, which should ensure our longer term outlook mirrors that of a consumer packaged goods company, not a traditional pharmaceutical company. 4. Focus our resources on bringing new products to the market (output), not R&D spend (input). Traditionally, pharmaceutical companies have pointed to R&D spend as the best metric for predicting new product flow in the coming years. More recently, most of these companies have had to resort to in licensing products and M&A activity to fill their new product gaps. By contrast, we have focused our R&D spending on line extensions and higher probability, late stage development programs. Member of BIOTECanada First Canadian Big Pharma Company : R&D to sales ratio in 2013 in Canada: 0%
35 Roadmap to a Rational Pharmacare Policy A national strategy to develop institutional capacity to contain costs, improve health outcomes and achieve sustainability. Includes: National drug plan covering all Canadians National formulary Systematic recourse to PCPA to contain cost (cannot work if half the market has an open formulary) Elimination of co pays or deductibles based on official prices Monitoring prescribing habits/promoting rational use of medicines
36 Cost and Savings for Implementing Universal Pharmacare in Canada
37
38
39 Conclusion A universal pharmacare program is not a panacea. But, if implemented with the needed institutional capacities: It would improve access to medicines and health outcomes. It would generate savings of 10% to 41% on prescription drugs. It would increase net disposable income for all Canadians, reduce labour costs for Canadian enterprises, and allow public reinvestments elsewhere in the health care system.
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41 Additional references on the issue: Marc André Gagnon. Roadmap to a Rational Pharmacare Policy (CFNU): report/index.html Marc Andre Gagnon. The Economic Case for Universal Pharmacare (CCPA and IRIS) : Pharmacarenow.ca Steve Morgan, Jamie Daw and Michael Law. Rethinking Pharmacare in Canada (C.D. Howe Institute): Pour un Régime d assurance médicaments entièrement public (Union des consommateurs): comites/sante/rapports et memoires/pour unregime dassurance medicaments entierement public/ Prescription Pharmaceuticals in Canada: Unintended Consequences (Standing Senate Committee on Social Affairs, Science and Technology): e.pdf Don Husereau and Philip Jacobs. Investigation and Analysis of Options to Enhance Canada's Patented Medicine Price Ceiling Regulatory Regime (Institute of Health Economics):
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