Rare disease drugs strategy, standard coverage in CLHIA’s 2020 budget wish list

The Canadian Life and Health Insurance Association is recommending the federal government develop a strategy for high-cost drugs for rare diseases, potentially by harmonizing catastrophic drug coverage across the country.

In its August federal budget submission to the standing committee on finance, the association noted specialty drugs, including those for chronic and rare disease, made up just two per cent of total prescription claims, but 33 per cent of total costs, in 2018.

“High-cost drugs are a challenging and evolving class of prescription medications. Their unique characteristics and high costs may require a separate strategy around coverage to ensure Canadians have access,” wrote the CLHIA, adding it commended the government’s $500-million commitment in its 2019 budget toward funding for high-cost drugs for rare diseases. 

Read: Budget 2019: Feds to develop a strategy for high-cost drugs for rare diseases

The association also recommended the federal government work with provinces, territories and private insurers to develop a standard list of medicines for which all Canadians would be covered.

“Private insurers want to work with governments to ensure access across the country, not only to this standard list of medicines, but also to high-cost medicines,” wrote the CLHIA. “Governments should work together to make sure anyone who needs coverage can get it, while ensuring that out-of-pocket costs are not a barrier. Canadians need to be better able to navigate existing public plans so that they can access the coverage they are entitled to.”

The CLHIA also said it supports the government’s reforms to the Patented Medicine Prices Review Board regulations, which are due to be implemented on Jan. 1, 2021. “We believe . . . the proposed framework strikes an appropriate balance between paying fair prices that contribute to an environment conducive to pharmaceutical innovation and ensuring Canadians no longer pay among the highest prices in the world for medication.”

Read: PMPRB publishes new draft guidelines, launches 30-day consultation

Meanwhile, in its own federal budget submission, Innovative Medicines Canada is calling on the government to suspend the changes to the PMPRB rules and to “strike a balance between affordability and access to innovative medicines and vaccines.”

The IMC argued that suspending the changes through an order in council would help to stabilize the pharmaceutical industry at a critical time. “The global outbreak of the novel coronavirus has shone a light on the importance of the critical investments required to create and strengthen models for innovation within Canada’s pharmaceutical ecosystem. . . . Suspending these detrimental regulations would enable the pharmaceutical and vaccine industry to avoid significant job loss and reductions in Canadian clinical trials.”