Amid the debate on health-care reform, U.S. influence on Canadian pharmacare policy, and Common Drug Review, there has been a roaring silence around what should be at the absolute heart of the matter: patients who need prescription medication to maintain their basic quality of life?
Canada announced a new Common Drug Review in January 2002, after a First Ministers conference in Victoria, B.C. The idea was to simplify and streamline the prescription-medication component of our provincial health-care systems by creating a national agency that would act as a clearinghouse and eliminate the need for each province and territory to conduct costly independent reviews of drugs before deciding whether to list them on provincial formularies and make them available to patients. The Common Drug Review was to be a nationwide body to review drugs and make them available for provincial listing.
It was a good idea -- and it's already failing. Health Canada still reviews and approves drugs; the provinces and territories still conduct their own reviews; the Common Drug Review inserts itself between the two as a new and possibly unnecessary layer that has little influence on decisions at the provincial level. It's just more red tape. Basically, a "yes" from the Common Drug Review means "maybe," and a "no" means "no" to a provincial listing, even after Health Canada has approved the drug.
Had the Common Drug Review been implemented as originally conceived, it would have reduced delays, reduced costs, and benefited patients. Had it been implemented as promised, Canadians in P.E.I. would have access to the same medications as those in Victoria or Montreal. At present, they don't.
Even with CDR, Canada's 10 provinces have 10 different approaches to deciding which newly approved medicines should be covered on their provincial formularies. By waiting for provincial formularies to list new medications (as long as 15 months), patients face additional delays once new medicines have received approval from Health Canada. In some cases, this means Canadians may wait as long as three years for a drug already benefiting patients in Sweden, Norway, the United States, Australia or Britain.
If CDR really worked we could have a true national drug program -- once a drug is approved by Health Canada, it would be automatically on every formulary for access by all Canadians. We could then take the money currently being wasted on duplication and redundancy and put it at the other end of the system -- and build in a way to monitor patients' experience with the medications, to ensure doctors, pharmacists and patients hear of both adverse reactions and positive outcomes.
Indeed, another flaw in CDR is the current lack of patient involvement -- despite the fact that such participation was urged in both the Romanow and Kirby reports on health care. The CDR should ensure that patients have a say in what medicines are available under the public reimbursement system.As Canada wrestles with these questions, matters are made more complex by our huge neighbour to the south. The Pharmaceutical Research and Manufacturers Association of America has funded a million-dollar lobbying campaign to "change the Canadian health-care system." Simply put, this group wants to raise the price of prescription drugs in Canada to U.S. levels.
Frankly, Canadians have enough problems gaining access to needed medications without U.S. interference. Our policymakers need to show some intestinal fortitude on this issue. There is a principle worth defending here: the preservation of the Canadian approach to health care, characterized by a strong belief in the rights and interests of patients.
Besides, we have an enviable health system in Canada, but it's not as enviable as some believe. The Therapeutic Products Directorate, part of Health Canada, which is responsible for reviewing new drugs, is slower than other countries: Today, it takes about 714 days for new drugs to be approved in Canada, more than double the targeted length of time the federal government has set for itself. In a 2002 study, U.S.-based health analyst Dr. Nigel Rawson concluded that "the median approval time in Canada continues to be significantly longer than the times achieved in Sweden, the U.K. and the U.S., and it remains considerably longer than Canada's own target."
Let's fix this. What we're talking about is access to medicine. It's about getting the right drugs at the right cost to Canadians who need them. It's about getting rid of excess red tape. It's about creating an equitable system from province to province. And it's about quality of life for all Canadians.
Kathy Kovacs Burns, who teaches at the University of Alberta, is co-chair of the Best Medicines Coalition.