ACTIVITIES OF THE PAN-CANADIAN PHARMACEUTICAL ALLIANCE: AN OBSERVATIONAL ANALYSIS
Main Article Content
Keywords
Drug reimbursement, price negotiation, economic evaluation, prioritization.
Abstract
Background
The pan-Canadian Pharmaceutical Alliance (pCPA) was established in 2010 to negotiate confidential prices for drugs coming forward from Canada’s centralized health technology assessment (HTA) agency reviews, on behalf of the participating public drug plans.
Objective
To analyze the activities of the pCPA, to determine: alignment of HTA agency recommendations and pCPA negotiation decisions; the role of health economics in pCPA activities; and patterns of implicit prioritization.
Methods
The analysis was based on the archive of drugs handled through the pCPA, as posted on its website. The period of observation was from inception to August 31, 2017. HTA recommendations were sourced from the websites of the Common Drug Review (CDR) and the pan-Canadian Oncology Drug Review. Descriptive and statistical analyses were conducted.
Results
The dataset contained 206 drug-indication pairings. There was close but imperfect alignment between HTA agency recommendations and the pCPA’s decisions to negotiate; deviations occurred only with CDR-reviewed drugs. The median incremental cost-effectiveness ratio of negotiated drugs was $168K/QALY for oncology drugs, but $70K/QALY for non-oncology drugs. The time to initiate negotiations was dramatically shorter for oncology versus non-oncology drugs (mean 54 versus 263 days) and also differed between therapeutic areas at CDR. The time required for PCPA activity was surprisingly similar for drugs recommended without a price condition and for those conditional on a price reduction.
The pan-Canadian Pharmaceutical Alliance (pCPA) was established in 2010 to negotiate confidential prices for drugs coming forward from Canada’s centralized health technology assessment (HTA) agency reviews, on behalf of the participating public drug plans.
Objective
To analyze the activities of the pCPA, to determine: alignment of HTA agency recommendations and pCPA negotiation decisions; the role of health economics in pCPA activities; and patterns of implicit prioritization.
Methods
The analysis was based on the archive of drugs handled through the pCPA, as posted on its website. The period of observation was from inception to August 31, 2017. HTA recommendations were sourced from the websites of the Common Drug Review (CDR) and the pan-Canadian Oncology Drug Review. Descriptive and statistical analyses were conducted.
Results
The dataset contained 206 drug-indication pairings. There was close but imperfect alignment between HTA agency recommendations and the pCPA’s decisions to negotiate; deviations occurred only with CDR-reviewed drugs. The median incremental cost-effectiveness ratio of negotiated drugs was $168K/QALY for oncology drugs, but $70K/QALY for non-oncology drugs. The time to initiate negotiations was dramatically shorter for oncology versus non-oncology drugs (mean 54 versus 263 days) and also differed between therapeutic areas at CDR. The time required for PCPA activity was surprisingly similar for drugs recommended without a price condition and for those conditional on a price reduction.
References
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2. Canadian Institute for Health Information. Prescribed Drug Spending in Canada, 2017. A Focus on Public Drug Programs. Ottawa, ON: CIHI; 2017.
3. Rocchi A, Miller E, Hopkins RB, Goeree R. Common drug review recommendations: an evidence base for expectations? Pharmacoeconomics 2012;Mar 30:229–46.
4. Chabot I, Rocchi A. Oncology drug health technology assessment recommendations: Canadian versus UK experiences. Clinicoecon Outcomes Res 2014;6:357–67.
5. Mills F. The changing role of cost-effectiveness in common drug review recommendations. Value Health 2017;20:A61.
6. The pan-Canadian Pharmaceutical Alliance website. [Internet] Available at: www.candaspremiers.ca/ pan-canadian-pharaceutical-alliance/.
7. Husereau D, Dempster W, Blanchard A, Chambers J. Evolution of drug reimbursement in Canada: the pan-Canadian Pharmaceutical Alliance for new drugs. Value Health 2014;17;888–94.
8. Milliken D, Venkatesh J, Yu R, Su Z, Thompson M, Eurich D. Comparison of drug coverage in Canada before and after the establishment of the pan-Canadian Pharmaceutical Alliance. BMJ Open 2015;5:e008100. doi: 10.1136/ bmjopen-2015-008100
9. Mills F. The effect of the pan-Canadian Pharmaceutical Alliance on provincial listing times and uniformity. Value Health 2017;5:A43.
10. Millson B Zhang Y. pCPA/CDR/pCODR changes and impact to market access in Canada. Value Health 2016;19:A280
11. Patent Medicines Pricing Review Board. PMPRB guidelines scoping paper. [Internet] Available at: www. pmprb-cepmb.gc.ca/CMFiles/Consultations/scoping_pa-per/pmprb_scoping_paper_e.pdf.
12. IBM Canada. Pan Canadian Drugs Negotiations Report. [Internet] Available at: www.canadaspremiers.ca/wp-content/uploads/2013/12/pan_canadian_drugs_neotia-tions_report_march22_2014.pdf.
13. Government of Canada. Notice of Compliance (NOC) database. [Internet] Available at: https://health-products. canada.ca/noc-ac/ndex-eng.jsp.
14. Canadian Agency for Drugs and Technology in Health. Common Drug Review (CDR) reports. [Internet] Available at: www.cadth.ca/about-cadth/what-we-do/products-services/cdr/reports. Find a review (pCODR). www.cadth.ca/pcodr/find-a-review.
15. O’Quinn S. Pan Canadian Pricing Alliance. The goliath of market access. [Internet] October 2013. Available at: http:// docplayer.net/26238352-Pan-canadian-pricing-alliance-pcpa-the-goliath-of-market-access-october-2013.html.
16. Canadian Agency for Drugs and Technology in Health. Procedure for the CADTH Common Drug Review. [Internet] August 2014. Available at: https://www.cadth.ca/ media/cdr/process/Procedure_for_CADTH_CDR.pdf.
17. Pan-Canadian Pharmaceutical Alliance. CAHR Update from the Pan Canadian Pharmaceutical Alliance Office. [Internet] February 8, 2017. Available at: http://c.ymcdn. com/sites/www.cahr-acrss.ca/resource/resmgr/Oncol-ogy_Day_PPTs/Anchalee_Sirsombun_and_Sang_.pdf.
18. Casey, B (chair). Pharmacare now: prescription medicine coverage for all Canadians. Report of the Standing Committee on Health. April 2018. [Internet] Available at: http://www.ourcommons.ca/content/Committee/421/ HESA/Reports/RP9762464/421_HESA_Rpt14_PDF/421_ HESA_Rpt14-e.pdf.
2. Canadian Institute for Health Information. Prescribed Drug Spending in Canada, 2017. A Focus on Public Drug Programs. Ottawa, ON: CIHI; 2017.
3. Rocchi A, Miller E, Hopkins RB, Goeree R. Common drug review recommendations: an evidence base for expectations? Pharmacoeconomics 2012;Mar 30:229–46.
4. Chabot I, Rocchi A. Oncology drug health technology assessment recommendations: Canadian versus UK experiences. Clinicoecon Outcomes Res 2014;6:357–67.
5. Mills F. The changing role of cost-effectiveness in common drug review recommendations. Value Health 2017;20:A61.
6. The pan-Canadian Pharmaceutical Alliance website. [Internet] Available at: www.candaspremiers.ca/ pan-canadian-pharaceutical-alliance/.
7. Husereau D, Dempster W, Blanchard A, Chambers J. Evolution of drug reimbursement in Canada: the pan-Canadian Pharmaceutical Alliance for new drugs. Value Health 2014;17;888–94.
8. Milliken D, Venkatesh J, Yu R, Su Z, Thompson M, Eurich D. Comparison of drug coverage in Canada before and after the establishment of the pan-Canadian Pharmaceutical Alliance. BMJ Open 2015;5:e008100. doi: 10.1136/ bmjopen-2015-008100
9. Mills F. The effect of the pan-Canadian Pharmaceutical Alliance on provincial listing times and uniformity. Value Health 2017;5:A43.
10. Millson B Zhang Y. pCPA/CDR/pCODR changes and impact to market access in Canada. Value Health 2016;19:A280
11. Patent Medicines Pricing Review Board. PMPRB guidelines scoping paper. [Internet] Available at: www. pmprb-cepmb.gc.ca/CMFiles/Consultations/scoping_pa-per/pmprb_scoping_paper_e.pdf.
12. IBM Canada. Pan Canadian Drugs Negotiations Report. [Internet] Available at: www.canadaspremiers.ca/wp-content/uploads/2013/12/pan_canadian_drugs_neotia-tions_report_march22_2014.pdf.
13. Government of Canada. Notice of Compliance (NOC) database. [Internet] Available at: https://health-products. canada.ca/noc-ac/ndex-eng.jsp.
14. Canadian Agency for Drugs and Technology in Health. Common Drug Review (CDR) reports. [Internet] Available at: www.cadth.ca/about-cadth/what-we-do/products-services/cdr/reports. Find a review (pCODR). www.cadth.ca/pcodr/find-a-review.
15. O’Quinn S. Pan Canadian Pricing Alliance. The goliath of market access. [Internet] October 2013. Available at: http:// docplayer.net/26238352-Pan-canadian-pricing-alliance-pcpa-the-goliath-of-market-access-october-2013.html.
16. Canadian Agency for Drugs and Technology in Health. Procedure for the CADTH Common Drug Review. [Internet] August 2014. Available at: https://www.cadth.ca/ media/cdr/process/Procedure_for_CADTH_CDR.pdf.
17. Pan-Canadian Pharmaceutical Alliance. CAHR Update from the Pan Canadian Pharmaceutical Alliance Office. [Internet] February 8, 2017. Available at: http://c.ymcdn. com/sites/www.cahr-acrss.ca/resource/resmgr/Oncol-ogy_Day_PPTs/Anchalee_Sirsombun_and_Sang_.pdf.
18. Casey, B (chair). Pharmacare now: prescription medicine coverage for all Canadians. Report of the Standing Committee on Health. April 2018. [Internet] Available at: http://www.ourcommons.ca/content/Committee/421/ HESA/Reports/RP9762464/421_HESA_Rpt14_PDF/421_ HESA_Rpt14-e.pdf.
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Published
Aug 7, 2018
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How to Cite
Rocchi, A., & Mills, F. (2018). ACTIVITIES OF THE PAN-CANADIAN PHARMACEUTICAL ALLIANCE: AN OBSERVATIONAL ANALYSIS. Journal of Population Therapeutics and Clinical Pharmacology, 25(2), e12-e22. https://doi.org/10.22374/1710-6222.25.2.2
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How to Cite
Rocchi, A., & Mills, F. (2018). ACTIVITIES OF THE PAN-CANADIAN PHARMACEUTICAL ALLIANCE: AN OBSERVATIONAL ANALYSIS. Journal of Population Therapeutics and Clinical Pharmacology, 25(2), e12-e22. https://doi.org/10.22374/1710-6222.25.2.2