George wyatt cord cdr-p codr - slides - 2015-11-18 v2

Public Drug Plan Reimbursement

in Canada

November 19, 2015 George Wyatt

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


11

189

141

52

157

89

0

20

40

60

80

100

120

140

160

180

200

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


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


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


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


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


hZps://www.cadth.ca/pcodr/paLent-‐input-‐and-‐feedback

CADTH Newsletter https://www.cadth.ca/subscribe


Pan-Canadian Pharmaceutical Alliance (pCPA) – 2015-09-30


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


pCODR – Public Plan Reimbursement Based on pCODR Recommendations from 2012 through 2014


Average Completion Time


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


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)

Summary

•  Quebec acts quicker than CDR / pCODR •  Patient input is important for

reimbursement recommendation •  pCPA process is delaying access to

medications •  Overall it takes almost 2 (non-cancer) to 3

(cancer) years from time of NOC to have drug reimbursement

George wyatt cord cdr-p codr - slides - 2015-11-18 v2

Government & Nonprofit