The report of consultant, IBM Healthcare, contracted under the direction of the Ontario Ministry of Health and Long-Term Care and other partnering provinces and territories to study the system of pan-Canadian price negotiations, has been publicly released. The report outlines IBM’s findings in terms of key themes, as well as recommendations for the price negotiation system in Canada from an organizational/governance standpoint.

Process

IBM consulted with several groups of stakeholders, including provincial and territorial drug program branches, provincial cancer agencies, manufacturers (brand name), industry groups (Rx&D, BIOTECanada), regulatory bodies (the pan-Canadian Oncology Drug Review, the Canadian Agency for Drugs and Technologies in Health, and the Patented Medicine Prices Review Board), patient groups, and cross-sector alliances (Canadian Generic Pharmaceutical Association, the Canadian Association of Chain Drug Stores, Canadian Association for Pharmacy Distribution Management, and the Canadian Pharmacists Association).

Common themes

The following common themes arose during the consultations:

  • Pan-Canadian Pricing Alliance (PCPA) goals are acceptable including non-price goals;
  • in principle, a single pan-Canadian negotiation is better than multiple parallel negotiations;
  • no current government body is seen as a “fit” for PCPA;
  • provincial subject matter expertise key to success of the PCPA;
  • resource constraints coping with the PCPA volume;
  • the PCPA is evolving and is a young alliance;
  • the PCPA needs to improve their communication and be more transparent;
  • the PCPA process is still informal and requires more consistency; and
  • metrics are required to evaluate and benchmark the PCPA performance.

Recommendations

The report includes a number of recommendations, ranging from general recommendations through to governance and process recommendations.

Some of the notable recommendations include considering changing name from “Pan-Canadian Pricing Alliance” to “Pan-Canadian Pharmaceutical Alliance”, standardizing templates (such as the contract known as “product listing agreements”, and letters of intent), and adopting a single common non-disclosure agreement.

The optimal governance model in the short to medium term is described as a “Secretariat Model”, which, the report explores, could be one of two differing models; the first would have three full time employees split in location and specialization across the country, with specialized roles for each.  Under the second option, the employees would be centrally organized.  They would not have specialized roles and would, as a team, support the portfolio of drugs negotiated by PCPA.  IBM recommends the second option.

Other process recommendations include, “establishing clear time estimates, benchmarks and targets for the PCPA process, and publishing historical times, targets and benchmarks on the same.”

Link to report

Pan Canadian Drug Negotiation Report, March 2014