On December 12, 2007 the House of Commons Standing Committee on Health released its long-awaited report on the Common Drug Review (CDR). Among other things, the Standing Committee has called for greater public involvement in the CDR, the introduction of an appeal process and specific approaches to review drugs for rare disorders and first-in-class medicines.
The committee conducted hearings from April through June 2007, hearing evidence from federal and provincial governments, the pharmaceutical industry, patient advocacy groups, health professionals, researchers and academics and officials from the Canadian Agency for Drugs and Technologies in Health (CADTH) which is responsible for the delivery of the CDR.
The committee's report represents an attempt to synthesize the often conflicting views of the witnesses who appeared before it. Describing the CDR as "a good start" and noting that participating drug plans consider it to be a positive example of intergovernmental cooperation, the committee members also "strongly agree with witnesses that further improvements are necessary." The committee expressed the hope that its recommendations will help the CDR achieve a higher level of satisfaction among those affected by its work and hopes that the Office of the Auditor General will conduct a value for money review of the CDR.
The Common Drug Review is a federal/provincial/territorial (F/P/T) process to review the clinical efficacy and cost effectiveness of new drugs for purposes of recommending coverage under public drug programs. Except for Québec, all public drug programs in Canada including six federal, nine provincial and three territorial drug plans, participate in the CDR. The committee notes that the federal government contributes 30% of CDR funding and that it is estimated that between 9 and 10 million Canadians are affected by CDR recommendations.
Given the intergovernmental nature of the CDR, the committee's specific recommendations are addressed to the federal government and invite it to work with its provincial and territorial CDR counterparts:
- To require an independent external performance evaluation within a year and subsequently at five year intervals;
- To enhance transparency by increasing the level of scientific and price information disclosed;
- To increase the current level of public involvement in the CDR through public attendance at open meetings of the Canadian Expert Drug Advisory Committee and through the creation of a public advisory body;
- To create a set of specific appeal criteria and a new appeal process which will require a separate group of reviewers; allow members of the public, in addition to manufacturers, to appeal; and establish a clear time frame for an appeal decision; and
- To urge a specifically designed approach for the review of drugs for rare disorders and for first in class drugs.
These recommendations address many of the concerns raised by patient groups and pharmaceutical industry representatives before the committee in its hearings
CADTH has, in recent years, begun to take steps to address concerns about public involvement by appointing public members to the Canadian Expert Drug Advisory Committee and to propose, this fall, measures to increase the transparency of its activities. The House of Commons Standing Committee on Health has encouraged CADTH to accelerate these initiatives and go further.
In a CDR Update issued December 13, CADTH says that it welcomes the committee's suggestions and recommendations and looks forward to the federal government's response. CADTH will review the benefits and implications of the recommendations and bring them to the CADTH Board of Directors for consideration. It will also assist the federal government in preparing its response to the Standing Committee.
As an F/P/T body, governed by a 13-member jurisdictional Board appointed by F/P/T Deputy Ministers of Health, it is unclear how quickly the CDR will move to implement the recommendations of the Standing Committee on Health, but this report clearly increases pressure on the program to accelerate its actions to address the issues raised.
For a copy of the report of the Standing Committee on Health, please visit:
For a copy of CADTH's CDR Update, please visit: