OBJECTIVES:

The Canadian Agency for Drugs and Technologies in Health (CADTH) rigorously evaluates drugs in areas with high unmet need such as rare diseases (RD) or oncology, significantly reassessing the manufacturer-submitted incremental cost-effectiveness ratio (ICER). We aim to understand how CADTH’s pharmacoeconomic reassessments impact the outcomes of price negotiations with the pan-Canadian Pharmaceutical Alliance (pCPA) in Canada.

METHODS:

All publicly-available CADTH recommendations for rare and oncology drugs from Q3-2017 to Q2-2022 were identified and reviewed for the submitted and re-analyzed ICERs and any price reduction statements, followed by cross-referencing these drugs to the pCPA Negotiation Status database for their negotiation outcome. Qualitative were conducted to understand the main drivers of the recommendations and outcomes.

RESULTS:

A total of 37 RD and 140 oncology submissions were identified. Of these, 95% of RD and 79% of oncology drugs received a positive recommendation. On average, CADTH reanalyzed manufacturer-submitted ICERs to be 219% higher. Approximately 83 (47%) submissions had specific price reduction statements of which 30% were >90% discount required. All RD and 71% of oncology products with >90% price reductions received a positive recommendation. When RD products with >90% price reductions went to pCPA, 75% successfully completed negotiations, 0% ended without agreement, 0% chose not to negotiate, 25% are ongoing. When oncology products with >90% price reductions went to pCPA, 29% successfully completed negotiations, 0% ended without agreement, 14% chose not to negotiate, 29% are ongoing, and status is unknown for 28%.

CONCLUSIONS:

Despite significant ICER re-analyses, RD drugs were able to achieve successful price negotiation outcomes with pCPA. Oncology drugs received fewer positive recommendations and fewer >90% price reduction statements. Oncology drugs with >90% price reduction statements successfully completed price negotiations less frequently than RD drugs. Further research is required to understand the main driver of this disparity between RD and oncology drugs more deeply.