In 2014, spending on prescription drugs amounted to $28.8 billion in Canada. This accounted for 13.4 per cent of the health-care budget.
The Canadian Institute for Health Information reported that 42 per cent of spending on prescription drugs is funded by the public sector, leaving 36 per cent to private insurers and 22 per cent to consumers.
In response to the strain on provincial health-care budgets, the pan-Canadian Pharmaceutical Alliance (pCPA) was established in 2010. The goal of the pCPA was to reduce prices for prescription drugs across Canada through negotiation and bulk buying.
“Ultimately, the pCPA is about improving access to drugs, thereby improving the health of Canadians,” says Dean Eurich, associate professor in the School of Public Health. “However, the impact of initiatives like the pCPA is rarely evaluated.”
Working in conjunction with several private industry partners, Eurich and colleagues recently published a six-year assessment of the pCPA in BMJ Open. These partners included MILLREED Enterprises Ltd., J. Venkatesh Healthcare Consulting Inc., Janssen Inc. and Cornerstone Research Inc.
“Working with this group provided valuable perspective. Having access to their expertise and knowledge of the pCPA gave a more complete picture of how the initiative is functioning and potentially impacting Canadian patients,” explains Eurich.
Eurich and colleagues set out to determine whether establishing the pCPA resulted in significant changes in drug listing decisions across Canada. This includes both the introduction of new pharmaceuticals and the use of existing, approved drugs for treating different conditions—drug indications.
The researchers evaluated the pCPA on two points: first, drug listings and new drug indications and second, consistency of coverage across Canada. The study reviewed drug listings and indications three years prior to pCPA and three years following its implementation in nine provincial jurisdictions across Canada.
Eurich and colleagues reached a complicated conclusion—the pCPA has potential, but it also has some limitations.
The researchers did not observe significant impact on the overall proportion of drugs listed. Despite implementation of the pCPA, few changes took place. Three years after the pCPA, jurisdictions listed 36 per cent to 59 per cent of drug indications—nearly identical to the pre-pCPA listing of 35 per cent to 59 per cent.
This is potentially due to the limited number of drugs that had completed the pCPA negotiations within this three-year period. The researchers urge further assessment and suggest that the pCPA is likely to have a positive impact in the coming years.
“As more drugs are processed through the pCPA, the system should become more responsive. This will facilitate quicker decisions,” explains Eurich.
“Whether these decisions are ‘positive’ or ‘negative’ will come down to whether the drug is providing a value to Canadians. With a more standardized process, there will be greater consistency in drug decisions across the country.”
The report makes two recommendations. First, ongoing assessment of the pCPA is necessary in order to evaluate its impact. Second, efforts to improve transparency surrounding timelines, criteria and processes within the pCPA are crucial for continuation of the project.
“Information used to make policy decisions is often sensitive and based on imperfect data,” explains Eurich. “This makes evaluating the true impact of policies like the pCPA difficult. A more open and transparent process is required to ensure the best value and outcomes for all Canadians.”
“The pCPA is promising,” says Eurich. “At the end of the day, this initiative is designed to increase access to prescription medication for those who need it most. With time and some fine tuning, this policy could improve the health and wellness of people across Canada.”