In its submission to the Patented Medicine Prices Review Board’s draft guidelines, the Canadian Life and Health Insurance Association is suggesting that the board consider disbursing excess revenues from pharmaceutical companies to employers rather than just to the provincial and territorial public payers.

Currently, any excess revenues — determined by voluntary compliance undertaking or orders from the PMPRB — are paid to Canada’s receiver general and then returned to public payers based on an existing formula. But, argued the CLHIA in its August submission, “employers in Canada can incur significant excessive costs as well and we believe they should also share in any reimbursements. Accordingly, we recommend modifications to legislation to facilitate the PMPRB developing a mechanism to ensure that all stakeholders who were impacted by excessive revenues, including plan sponsors . . . who provide drug benefit plans for their employees, are reimbursed equally.”

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

The PMPRB published a new draft of its guidelines on June 15 and opened a 30-day consultation period. As a result, the board delayed implementing the new regulations from July 1, 2020 to Jan. 1, 2021.

In its submission, the CLHIA also suggested the PMPRB take into account additional factors when determining the maximum non-excessive price for medications than just those typically used by public payers. “A drug might help someone return to work, support productivity and improve mental health and such factors have traditionally not been given sufficient weight in health technology assessments. . . . A healthy, productive workforce ultimately benefits our public health system beyond reduction of hospitalizations and we believe these are valid considerations in any HTA assessment methodology.”

In its submission, the CLHIA also praised the PMRPB’s new requirement to evaluate the pharmacoeconomic value of patented medicines and its commitment to guideline monitoring and evaluation over time, which will assess the ongoing impact of the guidelines on drug prices and access to medicines. It also voiced its support for the new basket of reference countries, which excludes Switzerland and the United States — the only countries in the world with higher drug prices than Canada — and includes Australia, Belgium, Japan, the Netherlands, Norway and Spain, which all have lower prices.

Read: PMPRB changes within scope of Patent Act, rules federal court in judicial review

However, it highlighted some areas for further consideration, including reporting and enforcing the maximum rebated price for high-priority patented medicines. As well, in relation to the current pharmacoeconomic value threshold of $60,000 quality-adjusted life years for setting a drug’s maximum rebated price, the CLHIA encouraged the PMPRB to consider a process “that ensures the rigour of the review increases relative to the cost of the medication. The efficacy of this threshold, and similar benchmarks within the guidelines, will need to be monitored and assessed regularly going forward.”

It also suggested the board give careful consideration to enforcing patented medicines’ list price.

Read: Feds announce final changes to Canadian drug pricing regulations

Copyright © 2020 Transcontinental Media G.P. Originally published on benefitscanada.com

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Dave Patriarche:

Absolutely unbelievable! CLHIA wants the PMPRB to reimburse employers while the CLHIA members continue to coordinate claims incorrectly in Ontario. Insurers are intentionally mis-adjudicating claims with the Ontario Trillium Drug Plan to the tune of $100+ million a year. That means that employers are being overcharged that amount each and every year (and growing) simply because they say the province makes it too hard to adjudicate claims correctly.

Shame on them for pointing fingers when they refuse to do it right themselves. Lead by example CLHIA.

Monday, August 10 at 1:51 pm | Reply

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