The Cancer Medication Geographical Roulette in Canada

November 26, 2015

2

Webinar Overview• Introductions• Welcome to Guest Presenter– Susan Turner, Turner and Associates

• Review of Canadian Cancer Care• Cancer Treatment Coverage Map• The Cdn Cancer Meds Funding Review and Approval

Process• The Impact on Patients• Questions from Audience• Conclusion

3

Welcome Susan Turner

She has worked with the Canadian Cancer Society, the Canadian Cancer Action Network and the Campaign to Control Cancer, preparing reports and conferences and facilitating working groups to take action to improve cancer medications access.

Susan Turner, President of Turner & Associates Inc., is an independent consultant who has been involved in the area of cancer medications access for 10 years.

4

Review of Canadian Cancer Care• Four models in Canada– Comprehensive care provided via a provincial cancer

agency (BC, AB, SK)– Care co-ordinated by a provincial cancer agency, with

shared responsibility for treatment coverage (MB, ON)

– Centralized institutional/regional care with shared responsibility for treatment coverage (NF, PE)

– Hospital-based care with shared responsibility for treatment coverage (QC, NB, NS)

Source: Derived from data presented in Turner and Associates, Issues of Access to Cancer Drugs in Canada, April 2008, p. 15

Public Funding for Cancer Treatment Meds Funding Review Process

Cancer Agency Individual Hospitals /Regions

Public Drug Plan Cancer Agency Individual Hospitals /Regions

Public Drug Plan

Cancer Treatment Coverage Map

6

Canadian Pharmaceutical Review and Approval Process

Drug Development

Health Canada Review

Patented Medicine Prices Review Board

Health Technology Assessment

Provincial Drug Plans

Patient Access

HospitalsPrivate Drug

Plans

pCPA

7

Manufacturer submits

Health Canada issues NOC and DIN

Manufacturer submits

pCODR products CDR products Non pCODR, Non CDR

PCPA

No Negotiations, collective or individual Pan Canadian Negotiations Dealt with at the P/T levels

Confirm participation and lead jurisdiction

PCPA informs manufacturer of decision

PLA with individual jurisdictions

No

Yes decisions and No decisions

Yes

Province specific review where applicable

PCPA PROCESS

pCPA Process Map

LOI signed

7

8

What are the impacts on patients

…. and what can you do about it?

9

How well is Canada doing?1.Canada’s utilization of cancer

medicines ranked 13 among 14 developed countries in 2010

2. Canada ranked 21st of the 32 countries in the Organization for Economic Development and Cooperation (OECD) for access to cancer medicines in 2011-12

1. Professor Sir Mike Richards. Extent and causes of international variations in drug usage. A report for the Secretary of State for Health . July 2010.2. Wyatt Health Management. The Rx&D International Report on Access to Medicines 2011-12.

10

Impact #1: Not all cancer medicines are approved in Canada• More than 50 new cancer medicines and

indications are available outside Canada

11

Canadian Pharmaceutical Review and Approval Process

Drug Development

Health Canada Review

Patented Medicine Prices Review Board

Health Technology Assessment

Provincial Drug Plans

Patient Access

HospitalsPrivate Drug

Plans

pCPA

12

Why are some cancer medicines not available in Canada?

1. Medication is still in clinical trials2. Manufacturer has not submitted for approval

(or submitted later)3. Health Canada review process is slower

13

Regulatory approvals

• Median delay in approval = 9 months• Health Canada delay is 3 months

• Delays due to manufacturers unknown

14

Action: Advocacy for regulatory reform

15

Impact #2: Coverage is essential• The average cost of newer cancer medicines taken at

home is $72,300 (per course of treatment or per year)

• Many Canadian oncologists do not recommend a cancer medication if the patient is not covered

16

Canadian Pharmaceutical Review and Approval Process

Drug Development

Health Canada Review

Patented Medicine Prices Review Board

Health Technology Assessment

Provincial Drug Plans

Patient Access

HospitalsPrivate Drug

Plans

pCPA

17

Where are the biggest holes in our patchwork quilt of coverage?

18

Issue: Unequal coverage of take-home & hospital-administered cancer medicines

19

cancertaintyforall.ca

Action: CanCertainty

20

Issue: Provinces slow to approve new medications

21

Speed of public drug plan decisions

BC AB SK MB ON QC NB PE NS NL YT NIHB

Funded 53 52 56 54 59 46 42 21 46 41 24 4

Rejected 12 10 10 8 5 9 9 21 10 15 10 11

Under review/pCPA 10 10 6 12 9 17 21 32 18 16 8 27

Funding Status of New Cancer Drugs & Indications Marketed Since 2006 (as of Aug 2015)

22

Action: Advocacy for standards for provincial decision timelines

23

Issue: Strict authorization criteria

24

Action: Advocacy for independent appeals processes

25

Q&A

26

Canadian Cancer Survivor Network Contact Info

Canadian Cancer Survivor Network1750 Courtwood Crescent, Suite 210Ottawa, ON K2C 2B5Telephone / Téléphone : 613-898-1871E-mail jmanthorne@survivornet.ca or mforrest@survivornet.ca Web site www.survivornet.caBlog: http://jackiemanthornescancerblog.blogspot.com/Twitter: @survivornetcaFacebook: www.facebook.com/CanadianSurvivorNet Pinterest: http://pinterest.com/survivornetwork/