March 10, 2004
The Cost of Medication
Questions to Minister of Health Services Colin Hansen
R. Lee: I have a question about the cost of medication. We all know that medication costs have increased quite rapidly over the past few years. I wondered what steps are being taken to reduce the cost of medication. What kinds of criteria are used to put the medication on the Pharmacare list, and probably off the list? I would like to have some understanding on that kind of criteria.
For example, in one case my constituent called me, saying that this particular drug…. I won't mention it. He said that the drug is useful, and his doctor asked him to use that drug because he is allergic to other drugs. In that case, how do you help the patient if he is allergic to the other drugs but that particular drug is not covered under Pharmacare?
Hon. C. Hansen: The first stage of a new drug being introduced in Canada is to have what is referred to as notice of compliance by Health Canada. The federal government determines whether or not a new drug is safe, and only then can each of the provinces consider whether or not they will provide financial coverage for it. Once Health Canada says it is safe and it receives notice of compliance, doctors can prescribe it and pharmacists can dispense it, but it is not at that point eligible for financial assistance through the Pharmacare program. The manufacturer can then apply to the province to have that listed.
In the past every province did that independently. It is based on the science. It is based on how effective this particular medication is, compared to other medications that may be available. That's a review that in the past was done independently by every province. Today we're moving to what is referred to as a common drug review where all provinces, with the exception of Quebec, have agreed to participate in one review that would then be shared with all of the provinces. They would determine if, in fact, there is a significant benefit to the new medication compared to others already listed.
Once that is completed, if the common drug review says no, they don't think there is any significant benefit to a drug, then no provinces or territories will list it. If they in fact say there is a benefit, then it comes down to a decision by each province as to whether or not they can afford it. You know, that is a factor, because some of the new medications are extremely expensive. We have to make a decision whether or not we have the resources to provide the financial assistance under Fair Pharmacare to cover those particular medications. That, in a nutshell, is the process that leads to the approval of the medications.
R. Lee: He said a peer process…. If a patient is allergic to all other drugs and there's one drug which has not been tried yet, is there any process so that he or she can try this drug in the system?
Hon. C. Hansen: When the experts do their review of a new medication, they take into consideration patients that may benefit only from that particular drug. In some cases, if it is a drug that has very little benefit for most of the population but specific benefit for some, it may in fact be put in what we call a special authorization category, which means that physicians can put in a special authorization request for that patient to be provided with coverage for that particular medication.
Even when our experts determine that's not necessary, we also have exceptions that we will make in very unusual circumstances. Even though a drug is not listed as a benefit under Pharmacare, if there are unique circumstances, certainly the physicians can write to us, and in some cases we will make exceptions — in unusual cases.
