[e-drug] Canadians are considering copying the Australian PBAC

[Peter Mansfield <peter.mansfield@Flinders.edu.au>]

E-drug: Canadians are considering copying the Australian PBAC
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The following report, copied under fair use, from the Ottawa Citizen
newspaper was posted on the Canadian list Biojest by Anne Rochon
Ford.

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Rock may limit drugs covered by medicare
Considers a change to the way drugs are approved
Mark Kennedy
Ottawa Citizen
August 11, 2001

OTTAWA - Federal Health Minister Allan Rock is contemplating a
controversial change to the drug regulatory process to control
medicare's burgeoning costs of new prescription drugs, it has been
learned.

At a meeting of federal-provincial health ministers next month in
Newfoundland, Mr. Rock will urge his counterparts to find ways to
ensure public spending on pharmaceuticals is "cost effective."

One of several possible approaches is the creation of an advisory
council that would examine whether so-called me-too drugs -- new
pharmaceuticals that offer only marginally improved benefits over
existing drugs but carry a much higher price tag -- should be
publicly insured.

The panel, modelled on a similar citizens' group established by
Australia, would consist of medical ethicists, patients'
representatives, doctors, pharmacists, bureaucrats and health care
economists. [This has to be a reference to the PBAC Pharmaceutical
Benefits Advisory Committee.]

Its job would be to conduct cost-benefit analyses of new drugs and
deliver the findings to the provinces, which would collectively
decide whether to include the products in their list of insured drugs,
known as formularies.

Provinces cover the cost of drugs administered in hospital. They
also have drug benefit programs for pharmaceuticals administered
out of hospital to the elderly and to welfare recipients.

But drug costs have soared in recent years -- mainly because of
increased use and the introduction of new drugs.

In an interview with the Ottawa Citizen, Mr. Rock revealed how he
believes the federal government can help.

"I'm putting on the agenda for the September health ministers
conference a proposal to change the way we approve new drugs in
Canada so that we would no longer look just at safety and efficacy
-- as we have done traditionally -- but we'd add a third factor --
cost-effectiveness.

"We'd have some mechanism for assessing the marginal increase in
effectiveness of a new pharmaceutical product measured against
products already on the market, already in the formularies, in order
to avoid the situation where we approve me-too drugs that are
marginally more effective, but much more costly, thus driving up
the costs of pharmaceuticals."

He has been informally broaching the subject with his provincial
counterparts for several months and is sensitive to possible
complaints of federal intrusion in the provincial health care domain.

At the same time, he is aware of a recent trend that frustrates all
provinces: When a new me-too drug comes on the market, all
provinces are pressed to include it in their formularies.

Once one health ministry yields to the pressure, the others fall like
dominoes. At their annual meeting last week, the 10 premiers
agreed to focus on "developing constructive approaches" to four
key areas of health care including "pharmaceutical management."

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Comment:

It would be a good idea for the Canadians to talk with former PBAC
members David Henry and Don Birkett et al re what has happened
here so that they can learn from our success and also try to avoid
some of the mistakes. Don (the former chair of the PBAC) gave a
talk in Adelaide last week at which he listed a set of very sensible
and reasonable suggestions for improving the system including
giving the Committee equal access to the politicians as is given to
drug companies so that the politicians can hear both sides of the
story. I think PHARMAC in New Zealand provide a good example of
good communication with politicians. However it is easier in New
Zealand because the drug industry is less powerful there.

regards,

Peter

Dr Peter Mansfield
GP and consultant on marketing and appropriate therapeutics.
Visiting lecturer, Universities of Adelaide, Flinders, Queensland,
South Australia, Tasmania
Action against cardiovascular Risk Checklist (ARC) Project Officer,
Adelaide Western Division of General Practice
Director, HealthySkepticism.org formerly MaLAM (Medical Lobby
for Appropriate Marketing)
Defending health care from misleading and harmful marketing.
Advocacy, Research and Education.
e-mail: peter.mansfield@flinders.edu.au
www.healthyskepticism.org
PO Box 172 Daw Pk SA 5041 Australia
ph/fax +61 8 8374 2245


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