Industry and patient groups worry about lack of access for Canadians in need
As Health Canada undertakes a review of how patented medicines are priced in this country, the new president and CEO of the Ontario Chamber of Commerce, a 13-year veteran of the healthcare non-profit sector, is concerned that lowering drug prices by a large amount without assessing the impacts or addressing industry concerns could have a dramatic affect. It could stunt research and innovation, reduce Canadians’ access to medicines and jeopardize millions of dollars in research funding that could lead to breakthroughs in how a range of life- changing diseases are treated.
Last year, Health Canada announced its intention to overhaul Canada’s patented drug- pricing framework as set out by the Patented Medicines Prices Review Board ( PMPRB). There are five proposed changes aimed at reducing the government’s own spending on patented medicines, which Health Canada claims is now the second- largest expenditure in the in health spending. But an analysis of data from PMPRB and the Canadian Institute for Health Information (CIHI) shows that of the more than $ 233 billion that was spent on health care in 2016, only 6.7 per cent of that, or $15.5 billion, went to patented medicines.
Rocco Rossi, the new president and CEO of the Ontario Chamber of Commerce, spent the last five years as CEO of Prostate Cancer Canada and before that he was head of the Heart and Stroke Foundation of Ontario. He worries that this unprecedented move by the government could ultimately have a negative impact on Canadians whose last hopes lie in access to the latest lifesaving treatments.
He notes that over the last 40 years, mortality rates from prostate cancer alone have dropped by 40 per cent. Part of the decline can be explained by early detection, but a “significant” contributor to that figure, he says, is better treatment, including new medicines that have not only added years to patients’ lives but also maintained their quality of life.
“The ability to access the latest medicines, as well as the ability to be involved in clinical trials, have been very important ways of giving hope, not just to the individuals in the trial but to the larger community,” Rossi says. “I certainly wouldn’t want to have those opportunities put at risk.”
If changes to the price of medicines were to compromise pharmaceutical companies’ return on multi-million- dollar investments in new and innovative treatments, he warns, they may look for other countries in which to spend those research dollars. Were this to happen, not only would Canadian universities and other research institutions lose the much- needed funding that allows them to advance their work beyond what money from academic and non- profit sources can allow, but Canadian patients would see their opportunities to participate in those game-changing clinical trials disappear.
“There is the reality of public policy and the need to not bankrupt our system, but we need to be looking at lots of things and not just one part of the health-care budget, which is innovative medicines.”
The hard truth is that the cost of development of new and innovative medicines has become increasingly expensive, and increasingly complex, Rossi says. An area that can be particularly con- tentious when looking at the cost of medications are socalled “orphan drugs,” which are developed for very specific ailments that affect a small number of people.
“Whether there are 50 people affected by a disease or a million people, the process of developing, approving and testing a drug is roughly comparable,” he says.
But when fewer people need the medicine, the price tends to stay high because it’s not being purchased at a high volume.
“You can’t expect, particularly in the very rare diseases, for hundreds of millions if not billions of dollars to be spent in the development and somehow that’s then being offered at no cost on the part of the pharmaceutical companies,” he says.
The issue, he adds, is one of context, where the price of a single medicine doesn’t tell the whole story.
“We have to look at the broader context of impact on the economy, impact on our research community, impact on providing hope for our patient community, while at the same time creating a sustainable mix that’s not going to bankrupt our health-care system.”
Rossi says he understands that pharmaceutical companies may fear losing their investment if drug prices drop, but it’s even more of a crisis for families who are pinning their hopes on new medications.
“At the end of the day, we may know the price of everything and the value of nothing” he says. “And the value of hope to a parent, to a child, to a relative, to a neighbour, is infinite.”