Sending the Right Signals: How can HTA Optimally Inform PLAs

in the context of pCPA?

Brad Alyward

Nova Scotia Department of Health and Wellness

Introduction

Provide a brief overview of:

• Health Technology Assessment (HTA)

• Product Listing Agreement (PLA)

• pan-Canadian Pricing Alliance (pCPA)

HTA, PLAs and the pCPA

I get HTA, but PLAs…

PLA (Product Listing Agreement):

A confidential agreement between manufacturer(s) and a Province or Territory which is used to formalize the terms and conditions of a product funding decision.

…and pCPA??

pCPA (pan-Canadian Pricing Alliance):

• Collaboration between Provinces and Territories

• Announced by the Premiers in August 2010

• Currently co-led by Ontario and Nova Scotia

• Identify opportunities to conduct joint negotiations for brand name drugs

• Increased value to the health care system

Drug Funding Challenges

• Canadians and governments want consistent access to clinically effective medications.

• All public drug funders facing the same issues; value, affordability and sustainability.

• Rising costs increased the need to negotiate terms to improve value to the system.

• Need for confidential prices and the resulting product listing agreements (PLAs).

The Goals of PCPA

• Increase access to drug treatment options.

• Improve the consistency of drug listing decisions across the country.

• Capitalize on the combined buying power of jurisdictions.

• Reduce duplication of negotiations and improve utilization of resources.

• Achieve consistent pricing and lower drug costs.

The Role of HTA Before PCPA Manufacturer submits

Health Canada issues NOC and DIN

Manufacturer submits

pCODR products CDR products Non pCODR, Non CDR

Yes decisions and No decisions Province specific review where applicable

JURISDICTIONAL DECISION Variation in terms of:

Listing status Drug cost

Coverage criteria Product listing agreement

HTA in the Context of PCPA MANUFACTURER SUBMISSION

pCODR PRODUCTS CDR PRODUCTS

PCPA

PCPA NEGOTIATIONS No Negotiations Defer to P/T Level

CONFIRM LEAD AND PARTICIPATING JURISDICTIONS

MANUFACTURER INFORMED OF DECISION

NEGOTIATION

Province specific review where applicable

SIGNED LETTER OF INTENT

PLA WITH INDIVIDUAL JURISDICTIONS

HTA Informs PCPA Negotiations FINAL RECOMMENDATION (pERC, CDEC)

LIST LIST IN A SIMILAR MANNER

LIST WITH CRITERIA /

CONDITIONS

LIST IF COST EFFECTIVENESS

IMPROVED

DO NOT LIST AT SUBMITTED

PRICE DO NOT LIST

CLINICAL/COST EFFECTIVENESS

CLEAR RECOMMENDATIONS CLINICAL/COST EFFECTIVENESS UNCERTAIN

Pan-CANADIAN PRICING ALLIANCE NEGOTIATIONS

PLA Terms

INDIVIDUAL JURISDICTIONS