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Jane Philpott is the dean of the Queen’s University’s faculty of health sciences and a former federal minister of health. Danyaal Raza is an assistant professor at the University of Toronto’s department of family and community medicine, a family physician, and the former board chair of Canadian Doctors for Medicare.

For decades, Canada has held the unique distinction of not only having some of the highest drug prices in the world, but being the only high-income country with a universal health care system without a universal drug plan. After decades of the status quo, however, the past five years have brought the country tantalizingly close to tackling both.

But how quickly things can change.

In February, reporting by The Breach revealed that Health Minister Jean-Yves Duclos intervened last November in the affairs of the Patented Medicine Price Review Board, a quasi-judicial federal agency that regulates how much drugs cost in Canada. The next day, a stinging resignation letter from Matthew Herder, a member of the board, was made public; the agency’s executive director followed suit with his own exit the day after that. It is clear that all is not well at the board.

The NDP’s health critic is now calling for an investigation into intervention by Mr. Duclos. Questions are being raised as to whether the opposition NDP’s confidence-and-supply agreement with the governing Liberals, and the pharmacare commitment that is fundamental to it, can remain viable. What had first appeared as a hopeful oasis is at risk of dissolving into a mirage.

Why all the fuss? Because a serious opportunity to save Canadians’ money appears to have been given away. In 2017, the price review board released a policy document entitled Protecting Canadians from Excessive Drug Prices, which was endorsed by academics and other experts in the field. Under the plan, savings to Canadians over a 10-year period were projected to be $8.8-billion.

Then, for nearly six years, lobbyists representing brand-name pharmaceutical companies fought tooth and nail to weaken reforms, winning several delays along the way. They have threatened repeatedly that these reforms will halt the entrance of new drugs into the Canadian market and that amended regulations will hamper “the country’s ability to attract investment to our life-sciences sector.”

Industry lobbyists have been making these claims for 50 years, but the benefit of time has taught us that threats like this are only rhetoric, not reality. Britain, Sweden and France have all achieved lower drug prices while maintaining higher rates of research and development than Canada.

For example, just prior to the launch of the pricing reforms, sales of brand-name drugs in Canada hit a record $20-billion; meanwhile, manufacturers were investing just 4.4 per cent of sales into R&D. Indeed, despite these soaring revenues, the price review board reported in 2021 that “R&D expenditures to sales revenues for pharmaceutical patentees in Canada has been falling since the late 1990s” and that these levels have been “below the agreed-upon target of 10 per cent since 2003.” In 2021, it was a mere 3.4 per cent.

Studies have time and again shown that drug prices are not linked to the levels of industry R&D in a country, despite industry claims. R&D levels are instead linked to the locations of multinational head offices, local infrastructure to conduct clinical trials, and the presence of a strong scientific community doing research that provides the foundation for new drugs.

Despite the overwhelming evidence supporting the board’s drug pricing reforms, which represent an important building block for universal pharmacare, Mr. Duclos was characterized as interfering with deliberations in a manner that was “largely indistinguishable in form and substance from industry talking points,” according to Mr. Herder.

It is likely no coincidence that since the confidence-and-supply agreement was signed last March, lobbying from pharmaceutical and insurance groups opposed to pricing reforms and pharmacare has reportedly quadrupled. If this is sufficient to bend their ear, expectations that this government will implement reforms in drug pricing – let alone the much-heralded road map produced in 2019 by the Advisory Council on the Implementation of National Pharmacare – may have to be tempered.

The confidence-and-supply agreement may offer one final chance at redemption. It includes a commitment to pass a Canada Pharmacare Act by the end of 2023. Unfortunately, if the scuttled Patented Medicine Price Review Board reforms and associated resignations are any indication, whatever is contained in this act may be a shell of what many health advocates have spent decades working toward.

If there was ever a time to exercise leverage on a critical issue of health policy, we are facing such a moment. We need to do so, head-on.

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