Pangaea Express: Pricing & Reimbursement Trends…Connecting the Dots

April 28, 2016

By Marla Weingarten

The momentum towards a greater national drug pricing strategy for all drugs is taking shape across the country. The pCPA is starting to take over all pricing negotiations in place of individual provincial listing agreements.

Of particular significance, is the pricing strategy for SEBs. It appears they will now be requested to have transparent pricing for all Canadians, whether their drugs are paid for by public payer, private or cash. What will this mean for the future of SEBs in Canada? Will companies need to revisit their SEB strategy in light of transparent pricing? Also, what will be the impact on innovator biologics of transparent prices in the SEB market?

The signs of change for Canadian drug reimbursement are strong. In the last several months we have witnessed the following:

  1. Brent Fraser assumes the position as CADTH Vice-President, Pharmaceutical Reviews (previously Director of Ontario Public Drug Program)
  2. Establishment of the pCPA office and staff
  3. Quebec joins pCPA
  4. CADTH now publishing all submitted drug prices
  5. Private plan waits for CDR review (Manulife Drug Watch)
  6. Ontario no longer requires the Committee to Evaluate Drugs (CED) for drug reviews
  7. CADTH reviews drugs for off-label use …. heading towards indication extrapolation from a payers perspective
  8. Inflectra (infliximab SEB) launches at 70% of brand in Quebec then is subsequently listed at 56% of brand in Ontario
  9. All SEB and reference biologic manufacturer proposals will only be considered through pCPA and NOT individual provinces
  10. The introduction of an SEB will be requested to provide a reduction in the drug’s transparent price to benefit all Canadians* – public, private or cash paying

In essence, the dots are connecting towards a potential national drug pricing strategy. In addition, the potential introduction of transparent pricing for SEBs could possibly lead to the demise of PLAs for these drugs. If so, an important question to consider is whether this could also affect future biologic product launches in Canada?

For more information contact Marla Weingarten, Consultant, The Pangaea Group