Health Minister’s behaviour on drug-price reforms led to resignations, ex-board member says

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A former board member of Canada’s drug price regulator is challenging Health Minister Jean-Yves Duclos’s assertion that it failed to consult with him on price reforms, saying the behaviour of the minister’s office led to division and caused several resignations.

“It felt like we have been in a tunnel for a long time,” Matthew Herder said of the work on new rules designed to cap the prices of medications. After the minister requested that the Patented Medicine Prices Review Board suspend the review process, “We just felt like there was no light at the end of the tunnel any more,” he told The Globe and Mail in an interview.

The PMPRB, an independent, quasi-judicial body responsible for protecting Canadians from excessive drug costs, had been preparing new, long-awaited guidelines when Mr. Duclos asked for the suspension last November – a move that policy experts say may have permanently derailed the process.

Around the same time Mr. Duclos made the request, Innovative Medicines Canada, a pharmaceutical advocacy group, made a similar appeal, asking the PMPRB to pause the consultation process and “fundamentally reconsider” the guidelines.

It’s unusual for ministers of health to make such requests of the PMPRB. The move has led to the resignation of two board members and the executive director, and will be the subject of committee hearings in Ottawa next month.

After online media outlet the Breach first reported last month on Mr. Duclos’s request, the minister told reporters he had no choice but to make the ask because the PMPRB did not consult with him about the guidelines, as is required by law. (The guidelines are needed to help interpret and enforce the PMPRB’s new drug price rules. A public consultation on them was supposed to end Dec. 5, and they were supposed to come into force on Jan. 1 this year).

When asked about the matter on Thursday, Mr. Duclos’s office repeated the assertion that he was forced to ask for the suspension, citing the Patent Act. Press secretary Guillaume Bertrand said in an e-mail statement that Mr. Duclos receives regular updates on PMPRB activities from Health Canada and that the minister never received a formal invitation to be briefed by the PMPRB board chair.

But Mr. Herder, who resigned his board position last month over what he describes as inappropriate interference from Mr. Duclos’s office, said this is a misleading characterization “designed to obfuscate the truth.”

“It did not matter whether we sent an official invitation to the minister or reached out informally by text to his staff. Either way we weren’t getting a meeting,” he said.

The PMPRB made repeated attempts using multiple channels to reach Mr. Duclos’s office, Mr. Herder said, and all were either “met with silence” or initially responded to but never followed up on.

That’s why, when the minister’s letter arrived out of the blue in late November requesting a suspension, it took many at the board by surprise and was interpreted as more than a simple request, he said.

“A request becomes a demand when there’s been no conversation,” said Mr. Herder, who is director of the Health Law Institute at the Schulich School of Law at Dalhousie University in Halifax. “I would say the request crossed a line because there had been no dialogue.”

The same week Mr. Herder resigned, the long-time executive director of the board, Douglas Clark, announced he was stepping down. Mr. Clark did not cite the reason and declined an interview request.

In December, acting board chair Mélanie Bourassa Forcier also resigned. In an interview, Ms. Bourassa Forcier said she felt she had no choice but to do so, given that the consultation process had failed to meaningfully engage the minister, patient groups, industry players and others.

“I thought we had to take the time,” she said. “I really wanted to make sure we had a common understanding about the guidelines with all the stakeholders.”

Mr. Herder said the period before Ms. Bourassa Forcier resigned was tense as board members came to terms with the Health Minister’s unusual ask.

“The internal strain and division within the board itself was a direct result of the minister’s request, which followed on the heels of the industry’s request to stop consulting,” he said.

Records from the federal lobbyists registry show that Mr. Duclos and his staff met with representatives from pharmaceutical companies at least a dozen times last fall. The representatives were registered to lobby on a range of issues, including the PMPRB guidelines.

“This is the only minister of health to be appointed under the Liberal government who has not had a briefing on proposed changes to our guidelines,” Mr. Herder said. “To make such a request, after having no back and forth, after hearing from industry that they would make the exact same request, it starts to feel like this is the product of very powerful interests pushing the minister for this outcome.”

Next month, the House of Commons health committee will study the recent events involving the PMPRB.

For years, the PMPRB has been working to bring into force new rules designed to cap the prices pharmaceutical companies can charge for name-brand drugs. Canada has some of the highest drug prices in the world, and many hoped the new rules would help reduce costs and make medications more accessible.

The pharmaceutical industry was opposed to the changes, saying they would make it too difficult to bring new drugs to market in Canada. Innovative Medicines Canada declined an interview request and highlighted its December statement on the PMPRB guideline delay, which says that it provides the opportunity for “authentic stakeholder consultations.”