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Walter Robinson Vice President Government Affairs October 30, 2014

Walter Robinson Vice President Government Affairs October 30, 2014. PPF – Purpose of Today.

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Walter Robinson Vice President Government Affairs October 30, 2014

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  1. Walter Robinson Vice President Government AffairsOctober 30, 2014

  2. PPF – Purpose of Today A salient discussion to bring together senior leaders from across sectors to explore opportunities for collaboration in sustainably managing drug costs and enhancing health access in the Atlantic region

  3. Rx&D – Purpose of Today A salient discussion to bring together senior leaders from across sectors to explore opportunities to collaborate in sustainablymanagingdrug costs and enhancing health access and improving health outcomes in the Atlantic region and across Canada

  4. Health System Sustainability Asking the right questions … • Do our solutions support patients? • Are policy solutions rooted in evidence? • Do proposed approaches align with other policies? • Are we thinking short-term & long-term … $$$ and outcomes? • Have we unleashed the value of medicines?

  5. About Rx&D

  6. Our Members

  7. Contribution to Canada • 55 research-based companies (international and Canadian start-up) • Account for 46,000 Canadians jobs (direct and indirect) • Annually invest over $1B into pharmaceutical R&D and related activities • 3,000+ clinical trials across Canada • $750M into hospitals/communities • Annually contribute $3B to GDP • Support a vibrant and national life-sciences community

  8. About Rx&D Rx Medicines in Context

  9. Rx Medicines in Context • Life expectancy in Canada 1914 52 57 2014 80 84 • Public Health partner in newborn, school-age, seasonal and pandemic vaccination efforts • Steady increases in cancer, cardiovascular, diabetes, HIV/AIDs and other disease survival rates due to new innovative therapies • Cancer survival rates, especially in prostate, breast, lung and colorectal cancers have declined steadily since Canada’s peak of deaths/1,000 in 1988 • Total Rx medicines spend (public & private) in Canada -- 6.2%* * PMPRB/CIHI derivation -- 2012

  10. Value of Medicines: Life and Longevity Sources: OECD Health Data, *1980-2009; ** 1970-2009, ***1995-2009; *****1990-2004; Canadian Cancer Society, Canadian Cancer Statistics, ****1986-2012.

  11. Value of Medicines: System Impacts Fewer days in hospital: Canada Sources: OECD Health Data, *1980-2009; ** 1970-2009, ***1995-2009; *****1990-2004; Canadian Cancer Society, Canadian Cancer Statistics, ****1986-2012. Source: OECD Health Data 2012, 1980-2009, except **: 1986-2008.

  12. About Rx&D Rx Medicines in Context Pan-Canadian Pharmaceutical Alliance (PCPA)

  13. PCPA: Background • August 2010 – “Bulk Purchasing” discussion at Council of the Federation (CoF) • August 2014 – CoF announces $260M in total annual savings • Quebec to join, rumours of Federal Plans too, name change • Pricing is the driver … value of medicines, patient access, and system sustainability are tertiary considerations

  14. PCPA: Objectives * • Increase access to drug treatment options • Improve the consistency of drug listing decisions across the country • Capitalize on combined buying power of jurisdictions • Achieve consistent pricing and lower drug costs • Reduce duplication of negotiations and improve utilize of resources *Presented by PCPA – February 2013 at Pharmacare 2020 conference in Vancouver

  15. PCPA: Objectives • Increase access to drug treatment options • Improve the consistency of drug listing decisions across the country • Capitalize on combined buying power of jurisdictions • Achieve consistent pricing and lower drug costs • Reduce duplication of negotiations and improve utilization of resources

  16. PCPA: Status as of September 30, 2014

  17. PCPA in Context 10 million of 35 million Canadians covered by public drug plans After 4 yrs: $260M saved through CVPI / PCPA or $7.43 per CDN 10 public drug plans in 2014/2015 invest $11.3 billion $260M represents 2.3% of this amount Provinces in 2014/2015 devote $138 billion to healthcare $260M represents 0.19% of this amount Let’s address the other 99.81% ?

  18. About Rx&D Rx Medicines in Context Pan-Canadian Pharmaceutical Alliance (PCPA) The Real Driver: Utilization

  19. The Real Driver is Utilization • Patented Medicines Price increases have grown below the rate of inflation for 23 of the last 25 years(PMPRB PMPI -- 2013 Annual Report) • Canadian prices below MIP for last 12 years … 2001 to 2013 • “Growth in use, not price, is driving cost increases” (PMPRB October 2011) • Canada’s population is growing • The demographic mix is changing • There is a rise in the incidence of health problems that require drug therapy • The prescribing practices of physicians have changed • Drug therapy is becoming more popular than other forms of treatment • There are new drug therapies to treat conditions for which no effective treatment was previously available • Provincial transformation efforts can drive pharmacotherapy • Primary Care reform, age-in-place strategies and expanded scope of practice

  20. 25-Year Expenditure Trendline Analysis: Canadian Health Policy Institute (CHPI). Data: Canadian Institute for Health Information (CIHI), Patented Medicine Prices Review Board (PMPRB).

  21. Public System Use of Funds

  22. Rx Cost Curve: Already Bent

  23. About Rx&D Rx Medicines in Context Pan-Canadian Pharmaceutical Alliance (PCPA) The Real Driver: Utilization Adherence Supports Sustainability

  24. WHO: Adherence is the Issue • Poor adherence to treatment of chronic diseases is a worldwide problem of striking magnitude • The impact of poor adherence grows as the burden of chronic disease grows worldwide • The consequences of poor adherence to long-term therapies are poor health outcomes and increased health care costs • Improving adherence also enhances patients’ safety • Adherence is an important modifier of health system effectiveness

  25. Predictors of Non-Adherence • Disease with no symptoms • Complexity of regimen: once vs multiple times/day • Time gap around a visit to a healthcare professional • Side effects of a medication, adverse events tolerability • Levels of education, income, age, cognitive function, insurance coverage • 1/3 to 2/3 of medication related hospital visits • Diabetes: less than 40% adherence, 15% hospitalization rate close to 100% adherence, 4% hospitalization rate Non-Adherence by Disease State * • CVS up to 50%; Depression up to 57% • COPD (Asthma), Diabetes, GI disorders, neurological and HIV/AIDS * Risk Management and Healthcare Policy July 2014 – Johns Hopkins University School of Medicine

  26. Public Drug Programs – Clients/Conditions • Disease with no symptoms • Complexity of regimen: once vs multiple times/day • Time gap around a visit to a healthcare professional • Side effects of a medication, adverse events tolerability • Levels of education, income, age, cognitive function, insurance coverage • 1/3 to 2/3 of medication related hospital visits • Diabetes: less than 40% adherence, 15% hospitalization rate close to 100% adherence, 4% hospitalization rate Major Conditions Treated • CVS, Mental Health • COPD, Diabetes, GI disorders

  27. Magnitude of Non-Adherence 50% According to the WHO 50% of patients don’t take their medications and 33% never even fill their first prescription 1 $290 billion New England health care Institute (NEHI) estimates that overall poor adherence cost as much as $290 billion/year 2 3.5X Non-adherent chronic diseases patients cost their plan 3.5X more in claims 3 4% to 11% of US $2.7 trillion spend on healthcare 1 - Adherence to long-term therapies, Evidence for action, World Health Organization. 2003 2 - NEHI, How many more studies will it take? A collection of evidence that our health care system can do better. Low range around $100 billion/year. 2008 3 - Green Shield, GSC 2013 Drug Study, the inside story. 2013

  28. Adherence Impact in Canada $215 billion spend (public and private) 11% estimate: $24 billion in cost avoidance 4% estimate: $8.6 billion in cost avoidance

  29. About Rx&D Rx Medicines in Context Pan-Canadian Pharmaceutical Alliance (PCPA) The Real Driver: Utilization Adherence Supports Sustainability Partnership = Leadership

  30. Partnership = Leadership • Agree to collaborate, involve all stakeholders • Research, develop, fund and implement a Plan • Support patients, don’t blame them • Tailor solutions to diseases and patients • Train healthcare professionals • Integrate adherence efforts into system transformation • Multidisciplinary approach • HCPs, industry, governments, private payers, academe, PATIENTS • Measure it, be accountable, improve and report to Canadians

  31. Health System Sustainability Asking the right questions about Adherence … • Do our solutions support patients? • Are policy solutions rooted in evidence? • Do proposed approaches align with other policies? • Are we thinking short-term & long-term … $$$ and outcomes? • Have we truly unleashed the value of medicines?

  32. @RxandD@walterrobinsonwrobinson@canadapharma.org

  33. Value of Medicines • Better Health Outcomes • Superior clinical outcomes and prevent downstream complication • Better SE profile • Better adherence • Health Spending • Decreased need for adjacent health services • Increased efficiency in health care resources • Better value compared to alternative therapies • Broader Economy • Productivity gains • Reduced disability and absenteeism claims • Broader Society • Better quality of life for patients and for the informal caregivers

  34. Milestones HTA Review Negotiation with Payers Health Canada Submission Pre-discovery Recommendation issued (CDR, pCODR) Drug Discovery Drug Funding Process: Patent Filing to PCPA Negotiations 3-6 Years Up to 1 Year Pre-Clinical Variable Patent Filing ≤ 2 weeks Up to 2 Years Phase I Tabled at next PCPA bi-weekly teleconference Clinical Trials Phase II 6-7 Years Phase III ≤ 2 weeks Confirm no negotiation on “DO NOT LIST” FILES Participation confirmed and lead assigned Manufacturer Submission Completion of Phase III Research HC issues NOC & DIN ≤ 2 weeks HC Submission Letter sent to manufacturer informing of decision CDR Reviews Product OR Manufacturer submits to CDR/pCODR pCODR Reviews Product Variable Negotiation pERC/CDEC makes recommendation to drug plans Negotiation with Provinces OR Negotiation with PCPA PCPA/provincial review

  35. PhamaFocus 2018 (IMS Brogan) C $Billions Notes: Prices are reported at the ex-manufacturer level (price when sold from manufacturer to wholesaler or direct to pharmacies). Information includes OTC products where available. *Pharmacy market only. % growth, constant US $. Source: IMS Health. MIDAS. MAT June 2014

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