1. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH Pharmaceutical Policy in Canada: Reflections on a Shifting Landscape Steve Morgan, PhD Centre for Health Services and Policy Research University of British Columbia T H E C O M M O N W E A L T H F U N D

2. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH Canadian “Medicare” 

3. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH Canadian Pharmacare

4. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The coverage landscape: Under- and Un-insured for Routine Drug Costs Source: Applied Management (2000) "Canadians’ Access to Insurance for Prescription Medicines Volume 2”

5. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The coverage landscape: Under- and Un-insured for Catastrophic Costs Source: Applied Management (2000) "Canadians’ Access to Insurance for Prescription Medicines Volume 2”

6. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The financial landscape Source: CIHI and Statistics Canada

7. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The result, a national pastime… Provincial Inquiries –New Brunswick –Saskatchewan –British Columbia National Inquiries –Romanow –Kirby –National Forum on Health –House of Commons

8. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH What has been recommend? National Standards for Coverage –First-dollar coverage for vulnerable –Catastrophic coverage for all Canadians –Disease management coverage National agency/network –Drug regulation –Drug policy –Outcomes and policy research

9. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH What are policy makers seeing?

10. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The Shifting Landscape?

11. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The financial landscape Source: CIHI and Statistics Canada

12. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The demographic landscape Source: Statistics Canada

13. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH What are policy makers doing?

14. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH Coverage (…progress?) Provinces agreed to “reasonable coverage” against catastrophic drug costs At the same time… –BC eliminated seniors plan  universal income-based plan –Manitoba increased deductibles under its income-based plan –Ontario backed down on income-based plan (for now)

15. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH Drug Cost Control (the good news) Common Drug Review –Coordinated HTA for new drugs –High standards of evidence (for now) –Provinces retain coverage-decisions Outcomes-Based Coverage –Now in BC, NS, MB, SK … Utilization Initiatives –Data  NPDUIS –Analysis  COMPUS –Provincial Agencies  Quebec “Medicines Council”

16. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH Thank you