Alignment Between CDA Recommendations and pCPA Negotiation Outcomes: Exploring Factors Influencing Reimbursement Success
Author(s)
Viktoriia Zaitceva, MSc1, Kristian Eaves, MSc1, Mackenzie Mills, PhD1, Panos Kanavos, BSc, MSc, PhD2.
1HTA-Hive, London, United Kingdom, 2Health Policy, London School of Economics and Political Science, London, United Kingdom.
1HTA-Hive, London, United Kingdom, 2Health Policy, London School of Economics and Political Science, London, United Kingdom.
Presentation Documents
OBJECTIVES: This study assesses the alignment between Canadian Drug Agency (CDA) reimbursement recommendations and pan-Canadian Pharmaceutical Alliance (pCPA) negotiation outcomes. It examines factors contributing to failures in pricing negotiations for drugs considered to provide sufficient value to the Canadian healthcare system.
METHODS: CDA and pCPA websites were screened to identify and match publicly available reimbursement reviews and negotiation projects. HTA reports were analyzed to extract CDA’s conditions for reimbursement. Exploratory analysis, hypothesis testing (Chi-squared and Wilcoxon tests), and text pattern detection were performed using R (version 4.4.2).
RESULTS: As of January 2024, 921 projects were published on the pCPA website: 69.5% concluded with an agreement, 11.2% without agreement, 5.1% under active negotiations, and the rest not pursued. After matching CDA recommendations to completed negotiations, 355 projects from May 2005 to June 2024 were analyzed, with 301 (91.8%) receiving positive CDA recommendations (reimburse with conditions) and 20 (8.2%) negative recommendations (do not reimburse). A statistically significant association was found between CDA recommendations and pCPA negotiation results (p = 0.0022). Notably, 19 (5.4%) of projects with negative recommendations reached an agreement, while 39 (11%) with positive recommendations failed to secure one. Among positive CDA recommendations that failed in negotiations, 14 (38%) were contingent on price reductions to improve cost-effectiveness (ranging from 50% to 97%, averaging 82.5% of the submitted price), while 23 (62%) were contingent on referencing against the lowest-cost treatment alternative. Failed negotiations had a median duration of 226 days, significantly longer than the 143.5 days for successful ones (p = 0.00154).
CONCLUSIONS: The CDA's reassessment of cost-effectiveness analysis often results in substantial price reduction recommendations—up to 97%—to ensure a technology provides value for money. This may lead to unsuccessful negotiations with the pCPA due to manufacturers' reluctance to accept these conditions, potentially limiting patient access to valuable medicines.
METHODS: CDA and pCPA websites were screened to identify and match publicly available reimbursement reviews and negotiation projects. HTA reports were analyzed to extract CDA’s conditions for reimbursement. Exploratory analysis, hypothesis testing (Chi-squared and Wilcoxon tests), and text pattern detection were performed using R (version 4.4.2).
RESULTS: As of January 2024, 921 projects were published on the pCPA website: 69.5% concluded with an agreement, 11.2% without agreement, 5.1% under active negotiations, and the rest not pursued. After matching CDA recommendations to completed negotiations, 355 projects from May 2005 to June 2024 were analyzed, with 301 (91.8%) receiving positive CDA recommendations (reimburse with conditions) and 20 (8.2%) negative recommendations (do not reimburse). A statistically significant association was found between CDA recommendations and pCPA negotiation results (p = 0.0022). Notably, 19 (5.4%) of projects with negative recommendations reached an agreement, while 39 (11%) with positive recommendations failed to secure one. Among positive CDA recommendations that failed in negotiations, 14 (38%) were contingent on price reductions to improve cost-effectiveness (ranging from 50% to 97%, averaging 82.5% of the submitted price), while 23 (62%) were contingent on referencing against the lowest-cost treatment alternative. Failed negotiations had a median duration of 226 days, significantly longer than the 143.5 days for successful ones (p = 0.00154).
CONCLUSIONS: The CDA's reassessment of cost-effectiveness analysis often results in substantial price reduction recommendations—up to 97%—to ensure a technology provides value for money. This may lead to unsuccessful negotiations with the pCPA due to manufacturers' reluctance to accept these conditions, potentially limiting patient access to valuable medicines.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P53
Topic
Health Policy & Regulatory
Topic Subcategory
Pricing Policy & Schemes, Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas