HOUSE OF COMMONS CANADA PRESCRIPTION DRUGS PART 1 — COMMON DRUG REVIEW: AN F/P/T PROCESS Report of the Standing Committee on Health Joy Smith, MP Chair DECEMBER 2007 39th PARLIAMENT, 2nd SESSION The Speaker of the House hereby grants permission to reproduce this document, in whole or in part for use in schools and for other purposes such as private study, research, criticism, review or newspaper summary. Any commercial or other use or reproduction of this publication requires the express prior written authorization of the Speaker of the House of Commons. If this document contains excerpts or the full text of briefs presented to the Committee, permission to reproduce these briefs, in whole or in part, must be obtained from their authors. Also available on the Parliamentary Internet Parlementaire: http://www.parl.gc.ca Available from Communication Canada — Publishing, Ottawa, Canada K1A 0S9 PRESCRIPTION DRUGS PART 1 — COMMON DRUG REVIEW AN F/P/T PROCESS Report of the Standing Committee on Health Joy Smith, MP Chair DECEMBER 2007 39th PARLIAMENT, 2nd SESSION STANDING COMMITTEE ON HEALTH CHAIR Joy Smith VICE-CHAIRS Lui Temelkovski Christiane Gagnon MEMBERS Hon. Carolyn Bennett Luc Malo Patrick Brown Hon. Robert Thibault Patricia Davidson David Tilson Steven John Fletcher Judy Wasylycia-Leis Susan Kadis OTHER MEMBERS WHO PARTICIPATED Dave Batters Rahim Jaffer Colleen Beaumier Rob Merrifield Bonnie Brown Penny Priddy CLERK OF THE COMMITTEE Carmen DePape LIBRARY OF PARLIAMENT Parliamentary Information and Research Service Odette Madore Nancy Miller Chenier Sonya Norris iii THE STANDING COMMITTEE ON HEALTH has the honour to present its SECOND REPORT Pursuant to its mandate under Standing Order 108(2), the Committee has studied the subject of Prescription Drugs — Common Drug Review and presents its findings and recommendations. v TABLE OF CONTENTS PRESCRIPTION DRUGS — PART I: THE COMMON DRUG REVIEW: AN F/P/T PROCESS.................................................................................................. 1 INTRODUCTION ....................................................................................................... 1 PART I: THE CDR: A GOOD START ........................................................................ 2 1. What is the CDR?............................................................................................. 2 A. An Advisory Body to Public Drug Plans .................................................. 2 B. CDR Goals/Objectives ............................................................................ 2 C. CDR Governance and Funding ............................................................... 3 2. What Process Does the CDR Use in Reviewing New Drugs? .......................... 3 A. Initial CDR Review .................................................................................. 3 B. CEDAC Review and Recommendation................................................... 4 C. CDR Conflict of Interest and Confidentiality Guidelines .......................... 5 3. How is Cost-Effectiveness Determined? .......................................................... 5 A. The Method............................................................................................. 5 B. Expanded to Incorporate Other Outcomes.............................................. 5 C. Incorporating Human Values into the Review Process ........................... 6 D. Committee View ...................................................................................... 6 4. Has the CDR Reduced Duplication? ................................................................ 7 A. Single F/P/T Review of New Drugs ......................................................... 7 B. Different Drug Insurance Plan Reviews .................................................. 8 C. Committee View ...................................................................................... 8 5. Has the CDR Resulted in Longer Waits for New Drugs?.................................. 8 A. Overall Time-to-Listing ............................................................................ 8 vii B. CDR Review Timelines ........................................................................... 9 C. Health Canada and the CDR................................................................... 9 D. Drug Insurance Plans............................................................................ 10 E. Committee View .................................................................................... 10 6. What is the Impact of CDR Recommendations? ............................................ 10 A. Patient Access ...................................................................................... 10 B. Clinical Guidelines and Physician Practice............................................ 11 C. Drug Plans ............................................................................................ 11 D. Drug Plans in Other Countries .............................................................. 12 E. Committee View .................................................................................... 12 PART II: LOOKING FORWARD............................................................................... 13 1. Is the CDR Accountable to Governments?..................................................... 13 A. F/P/T Corporate Governance................................................................ 13 B. Call for a Review ................................................................................... 13 C. Committee View .................................................................................... 14 2. Is the CDR Process Open and Transparent? ................................................. 14 A. Current Situation ................................................................................... 14 B. More Accessible Information Needed ................................................... 14 C. Committee View .................................................................................... 15 3. Is the General Public Involved in the CDR Process?...................................... 16 A. Current Public Participation in CEDAC.................................................. 16 B. Other Jurisdictional Examples of Public Participation ........................... 16 C. Committee View .................................................................................... 17 4. Is there an Appeal Process under the CDR?.................................................. 17 A. Manufacturer Reconsideration .............................................................. 17 viii B. Public Appeal ........................................................................................ 18 C. Committee View .................................................................................... 18 5. Are Separate Processes Needed For Some Categories of Drugs?................ 18 A. Cancer Drugs........................................................................................ 18 B. Drugs for Rare Diseases....................................................................... 19 C. First-in-Class or Breakthrough Drugs.................................................... 19 D. Committee View .................................................................................... 20 CONCLUSION ....................................................................................................... 20 LIST OF RECOMMENDATIONS................................................................................... 21 APPENDIX A: COMMON DRUG REVIEW PROCESS ................................................. 23 APPENDIX B: TIMEFRAMES FOR COMMON DRUG REVIEW PROCEDURE........... 25 APPENDIX C: LIST OF WITNESSES ........................................................................... 27 APPENDIX D: LIST OF BRIEFS ................................................................................... 31 REQUEST FOR GOVERNMENT RESPONSE............................................................. 33 SUPPLEMENTARY OPINION BY THE BLOC QUÉBÉCOIS........................................ 35 ix PRESCRIPTION DRUGS — PART I THE COMMON DRUG REVIEW: AN F/P/T PROCESS INTRODUCTION In December 2006, the House of Commons Standing Committee on Health decided to pursue its study of prescription drugs, commencing with an examination of the status of, and progress made under, the Common Drug Review (CDR). The CDR is the single Federal/Provincial/Territorial (F/P/T) process that is used to review both the clinical efficacy and cost-effectiveness of new drugs. This review process, which takes place after Health Canada has approved a drug for sale, leads to a recommendation regarding formulary listing under participating publicly funded drug insurance plans. All plans participate in the CDR except Quebec. This includes six federal, nine provincial and three territorial drug plans, with the federal government contributing 30% of the CDR funding. It is estimated that between 9 and 10 million Canadians are affected by CDR recommendations on formulary listing. The six federal drug insurance plans that participate in the CDR are managed by Health Canada (eligible First Nations and Inuit individuals), Veteran Affairs Canada (eligible veterans), National Defence (members of the Canadian Forces), Royal Canadian Mounted Police (regular members and eligible retired members), Correctional Service of Canada (eligible federal offenders), and Citizenship and Immigration Canada (refugee protection claimants, sponsored convention refugees,