George wyatt cord cdr-p codr - slides - 2015-11-18 v2
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Flow of Public Drug Plan Reimbursement in Canada
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
Health Canada
Manufacturer
CDR/INESSS (non-‐cancer) pCODR/INESSS (cancer)
Public Plans
pCPA
PMPRB
CDR vs. Quebec (INESSS) Recommendations
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
11
189
141
52
157
89
0
20
40
60
80
100
120
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PosiLve CondiLonal NegaLve
CDR Quebec (non-‐cancer)
Conditional recommendations include: List in a Similar Manner, List with Criteria, List with Criteria/Condition, Not at Submitted Price
pCODR vs. Quebec (INESSS) Recommendations
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
Condition for INESSS means conditional of improved cost-effectiveness Positive for INESSS means conditional (no financial restrictions)
9 8
27
11
*
19
0
5
10
15
20
25
30
PosiLve CondiLonal NegaLve
pCODR Quebec (cancer)
CDR Recommendation Codes
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
2003 to October 2012
List (LIST) List in a Similar Manner (LSM)
List with Criteria (LWC) Do not List (DNL)
November 2012 To Present
List (LIST) List with Criteria/CondiDons (LWCC)
Not at SubmiFed Price (NSP) Do not List (DNL)
Under ConsideraDon
Fund (LIST) Fund with CondiDons (FWC)
Do not Fund (DNL)
www.cdrtracker.com
CDR Patient Input
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
Voluntary Pipeline NoLficaLon/ Mandatory NoLficaLon of Submission/Resubmission
CDR noLfies PaLent Groups for Input
DeliberaLon/RecommendaLon
CDR Review Process (Clinical/Economic/PaLent Input)
CDR Patient Input
hZps://www.cadth.ca/about-‐cadth/what-‐we-‐do/products-‐services/cdr/paLent-‐input
pCODR Patient Input
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
Mandatory NoLficaLon of Submission/Resubmission
pCODR noLfies Registered PaLent Groups for Input
IniLal RecommendaLon
pCODR Review Process (Clinical/Economic/PaLent Input)
Final RecommendaLon
Patient Groups can only provide feedback on the initial recommendation if they first provided input in the early stages of the review.
pCODR Patient Input
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
hZps://www.cadth.ca/pcodr/paLent-‐input-‐and-‐feedback
CADTH Newsletter https://www.cadth.ca/subscribe
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
Pan-Canadian Pharmaceutical Alliance (pCPA) – 2015-09-30
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
80
2
22
11
33
148
54%
1%
15% 7%
22%
100%
0
20
40
60
80
100
120
140
160
Complete Closed (agreement not
reached)
Ongoing Province No NegoLaLon Total
Number Percent
0
50
100
150
200
250
NL NS PEI NB QC ON MB SK AB BC NIHB Avg.
CDR – Public Plan Reimbursement Based on CDR Recommendations from 2004 through 2014
Reimbursed Do Not Reimburse No Decision Yet Removed from Formulary
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
pCODR – Public Plan Reimbursement Based on pCODR Recommendations from 2012 through 2014
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
Average Completion Time
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
203.4 203.1
392
247.1
340.4
0
50
100
150
200
250
300
350
400
450
CDR (Submission to RecommendaLon)
pCODR (Submission to RecommendaLon)
pCPA (CDR RecommendaLon to
CompleLon)
pCPA (pCODR RecommendaLon to
CompleLon)
pCPA (All RecommendaLon to
CompleLon)
Days
Time from NOC to Public Reimbursement
© Wyatt Management Consulting Inc., Oakville, Ontario, 2015. All Rights Reserved
676 628
835
721
800
590
773
1057
404
653 699 712
930
773
1005
1082
981
1094
875
1021 969
738
*
927
0
200
400
600
800
1000
1200
AB BC MB NB NL NS ON PEI QB SK NIHB Average
Days
CDR pCODR
* NIHB currently only covers drug that were reviewed prior to pCODR (e.g. jODR)
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