The proposed amendments to the patented medicines regulations by the Patented Medicine Prices Review Board could have a big impact on both the group insurance and pharmaceutical industry.
“The CLHIA is very supportive of PMPRB adjustments that may be coming,” said Joan Weir, director of health and disability policy at the Canadian Life and Health Insurance Association, during the Group Insurance and Pharmaceutical Committee’s fall event last week.
The PMPRB changes have faced challenges, including some court cases, which have brought its mandate into question. Following several implementation delays, uncertainty remains around whether the most recent revisions will go into effect on Jan. 1, 2022, as planned.
In addition, the ongoing coronavirus pandemic has had an impact on both the group benefits and the pharmaceutical industries. In 2020, the insurance industry paid out 24 per cent more in psychology claims, an additional $150 million in disability claims related to the coronavirus and $1.4 million less in dental claims, according to the CLHIA’s latest fact sheet.
The pandemic also highlighted the need to increase Canada’s biomanufacturing capacity, said Joe Farago, executive director of private payers and investment at Innovative Medicines Canada, also speaking at the event. “We need the right ecosystem here in Canada” to attract investment, remain a destination for global clinical studies and access innovative pharmaceuticals, he said.
Canada also needs to continue to support new drug innovation, he noted. Occasionally, new drugs are breakthroughs; however, more often they’re incremental advances that lead to something major. “Incremental innovations can deliver exceptional benefits, such as better clinical outcomes and patient experiences,” said Farago.
Rare disease treatments often result in higher treatment costs because they have the same development costs, but treat a much smaller targeted population, he said. These scientific advances have been — and will be — revolutionary for patients who may not have had any available treatments; however, he noted, “we recognize these pose challenges for drug plan [sponsors] and decision-makers who are paying for these plans.”
The federal government’s strategy for drugs for rare diseases, which was set out in its 2019 budget, is very important to the pharmaceutical industry and payers, noted Weir, though she acknowledged there’s a lot of work ahead.
The pharmaceutical industry believes the private payer market “plays an important role in providing broader and faster access to many drugs” said Farago. “This investment helps to improve the quality of life and ability of employers to help their employee stay at work and prevent expensive disability claims.”
The pharmaceutical industry, he added, “sees the need for open and constructive dialogue and how we can work collaboratively with private sector leaders to ensure Canadians continue to benefit from current and future advances in the treatment of diseases.”