OBJECTIVES:

The Canadian public reimbursement landscape has evolved rapidly over the years. One of the major development was the introduction of the pan-Canadian Pharmaceutical Alliance (pCPA) in 2010. The pCPA conducts joint federal/provincial/territorial negotiations for brand name drugs in Canada to achieve greater value for publicly funded drug programs and patients. The other development is an increasing number of drugs for rare diseases (DRDs) are entering the market. The objective of this study is to determine the impact of the pCPA on the time to reimbursement by Canadian public drug plans on all drugs and DRDs.

METHODS:

All data were obtained from publically available and proprietary sources. Key metrics included time from regulatory approval to initiation of health technology assessment (HTA), time from HTA submission to recommendation, time from HTA recommendation to pCPA negotiation, time from pCPA negotiation to completion, and time from HTA recommendation to public reimbursement. The later was compared to that of prior to pCPA (i.e., 2004-2009).

RESULTS:

Time from regulatory approval to initiation of HTA assessment for all drugs have decreased gradually since 2008 but was uneven for DRDs. The length of the HTA process (from submission to recommendation) was consistent over time with the exception of 2014 and 2015 in which record number of submissions were received). The time from HTA recommendation to pCPA negotiation was comparable for all drugs and DRDs. However, DRDs took approximately 1 month longer compared to all drugs to complete pCPA negotiation. Furthermore, across Canada, the time from HTA recommendation to public plan reimbursement for all drugs increased by almost one-third (more than 3 months) when pCPA negotiation was involved. DRDs took an additional one and a half-month to achieve public reimbursement.

CONCLUSIONS:

pCPA has substantially lengthened the time to reimbursement of important medications in Canada, with DRDs particularly affected.