Writing in the September edition of DIA’s Global Forum magazine, Dr Judith Glennie examines the specific steps that have been taken in the journey towards a National Pharmacare program in Canada, including the creation of a Canadian Drug Agency, a National Strategy for High-Cost Drugs for Rare Diseases, and an Advisory Panel for Pan-Canadian Prescription Drug List.
The creation of a National Pharmacare program has been a focus of the Federal Liberal government since their election in 2015. Various committees, reports, and government budget announcements have reiterated a commitment to National Pharmacare, although a specific path forward had yet to be articulated—until recently.
Over the past few months, the government has started to advance some of the recommendations in the final report of the Advisory Council on the Implementation of National Pharmacare. (See October 2019 Global Forum.) Movement has occurred on the proposed Canadian Drug Agency, the national strategy for drugs for rare diseases, and the creation of an essential medicines list, as key developments on the path toward National Pharmacare in Canada.
Canadian Drug Agency (CDA)
The concept of creating a Canadian Drug Agency (CDA) was first introduced in the March 2019 federal budget. At the time, it was positioned as a new federal agency, distinct from Health Canada and designed to improve access to and prices of prescription drugs. Specifically, it was envisioned to be responsible for:
- evaluating the comparative effectiveness of new prescription drugs (as opposed to the safety, efficacy, and quality assessment undertaken by Health Canada);
- negotiating prices with manufacturers on behalf of public drug plans;
- recommending which drugs provide the best value for money for Canadians;
- providing impartial and independent advice on drug evaluation and price negotiation; and
- consulting with provinces and territories on developing a national formulary (for the purposes of a National Pharmacare program).
Of note, many functions envisioned for the CDA have been and continue to be provided by organizations that already exist at a pan-Canadian and/or regional level in the form of the Canadian Agency for Drugs and Technologies in Health (CADTH) and the Institut national d’excellence en santé et en services sociaux (INESSS) for value assessments, and the pan-Canadian Pharmaceutical Alliance (pCPA) for national drug price negotiations. It is not known what role these organizations will have if the CDA comes to fruition.
In April 2021, Health Canada announced the appointment of the head of the Canadian Drug Agency Transition Office, officially launching the federal government’s foray into the creation of the CDA. The mandate of the office is to develop a vision and mandate for the CDA, advance work on pharmacare-related initiatives, and provide dedicated leadership and resources to support federal-provincial-territorial discussions. It will also engage provinces, territories, and stakeholders in discussions on the creation of a new agency.
The Transition Office recently started its work to develop a national formulary (see Advisory Panel for Pan-Canadian Prescription Drug List below) envisioned as a comprehensive, evidence-based list of prescribed drugs that will support consistent patient access to treatments across the country.
One of the key challenges of moving ahead with the CDA is that the existing component parts (particularly CADTH and pCPA) were developed by and have formal reporting relationships to provincial and territorial governments. The degree to which these jurisdictions might be willing to cede control over the governance of these bodies remains to be seen. In addition, if the CDA is intended to be national in scope, it is not clear what the implications are for INESSS and its activities in Quebec.