(May 29, 2006)<\/p>\n
Ontario Health Coalition
\n15 Gervais Drive, Suite 305
\nToronto, Ontario M3C 1Y8
\ntel: 416-441-2502
\nfax: 416-441-4073
\nemail: ohc@sympatico.ca
\nwww.ontariohealthcoalition.ca<\/p>\n
Introduction<\/strong> <\/p>\n Overview<\/strong> <\/p>\n Achieving a Balance<\/strong> <\/p>\n Initiatives supported by the OHC:<\/strong> <\/p>\n Additional Comments:<\/strong> <\/p>\n Recommendations:<\/strong> <\/p>\n
\nThe Ontario Health Coalition is a network of over 400 grassroots community organizations
\nrepresenting virtually all areas of Ontario. Our primary goal is to empower the members of
\nour constituent organizations to become actively engaged in the making of public policy on
\nmatters related to health care and healthy communities. To this end, we seek to provide to
\nmember organizations and the broader public ongoing information about their health care
\nsystem and its programs and services. Through public education and support for public
\ndebate, we contribute to the maintenance and extension of a system of checks and balances
\nthat is essential to good decision-making. We are an extremely collaborative organization,
\nactively working with others to share resources and information. We are a non-partisan
\ngroup committed to maintaining and enhancing our publicly-funded, publicly-administered
\nhealth care system. We work to honour and strengthen the principles of the Canada Health
\nAct.
\nOur members include over 70 local health coalitions in communities across the province;
\nlocal health action committees; health professionals\u2019 organizations; physicians that support
\nmedicare such as the Medical Reform Group; medical students\u2019 groups that support
\nmedicare; non-profit service providers; health sector unions; women’s groups such the Older
\nWomen’s Network, Voices of Positive Women and the Immigrant Women\u2019s Health Centre;
\nseniors\u2019 groups such as Canadian Pensioners Concerned, the Ontario Coalition of Senior
\nCitizens Organizations, CAW retirees, Alliance of Seniors to Protect Social Programs; low
\nincome and homeless peoples’ organizations including Low Income Families Together,
\nFood Share of Metro Toronto, Ontario Coalition Against Poverty; social service
\norganizations; workers\u2019 advocacy organizations; ethnic and multiracial minorities; the
\nOntario Federation of Labour; and other organizations such as the Canadian Council of
\nSouth Asian Seniors (Ont.), the Association of Neurologically Disabled, Ontario Coalition for
\nSocial Justice, Social Planning Council of Metro Toronto, Native Women’s Resource Centre,
\nAids Action Now, Birth Control and Venereal Disease Centre, the Canadian Federation of
\nStudents (Ontario division), Oxfam Canada and the Injured Workers Resource Centre,
\namong others.
\nWe are linked to the Canadian Health Coalition and provide provincial coordination of
\ncommunity-based health coalitions.<\/p>\n
\nIn this bill, the government proposes several key initiatives to control the cost of drugs in
\nOntario including supporting the widening of the use of generics to replace the higher cost
\nbrand name drugs, reducing the mark up on drugs and ensuring that the provincial
\ngovernment pays pharmacies for the actual cost of drugs rather than paying more than the
\npharmacies pay for them.
\nThe bill also changes the process for deciding what is on and off the Ontario Drug Benefits
\nPlan formulary and price levels for drugs. The creation of a new Executive Officer to replace
\ncabinet as the final decision-maker on these items is one that has raised several questions for
\nus.
\nThe bill has been accompanied by several announced initiatives that are not actually in the
\nlegislation, including the introduction of patient representatives in the drug review process
\nand a citizens\u2019 council. With the caveat that it is important for these patient and citizen
\nrepresentatives to be independent of drug industry influence, we support these initiatives.
\nIn our view, the legislation is an important first step. We have consulted with medical experts
\nwho conclude that the evidence is that the initiatives contained in this bill will not harm the
\nhealth of patients and will work to control drug costs.<\/p>\n
\nWe recognize that there are serious ethical dilemmas that must be weighed carefully in
\ndealing with public policy regarding access to medical treatment. Numerous organizations
\nand individuals advocate passionately for access to particular drugs and treatments that are
\nnot currently listed. There are also numerous organizations and individuals advocating for
\nparticular non-pharmaceutical treatments and care such as extensions to homecare,
\nimprovements in nursing homes and access to a comprehensive range of hospital and
\ncommunity care. We are also aware that the profit-seeking interests of the private for-profit
\ndrug – both brand name and generic – and pharmacy industries are actively lobbying on this
\nbill.
\nWe applaud the courage of the government in grappling with the difficult questions that
\ninvolve balancing the need for cost control in order to protect the health system as a whole –
\nincluding non-pharmaceutical care – and the need to protect access for people to drugs that
\nare not currently on the formulary. Obviously, in such decision-making it is necessary to
\nbalance the collective good, individual patient\u2019s rights, and the obligations of government
\nand health providers to protect patients from harm, among others. We believe that questions
\nabout what is covered or not covered and the ethics of protecting a patient or providing
\naccess to a drug that is not listed belong in the public realm and should be decided in as
\ndemocratic and transparent a fashion as possible.
\nOur approach to this bill is to balance the following:
\n\u2022 protect and extend the scope of the public health system under the principles of the
\nCanada Health Act
\n\u2022 support access to drugs with proven efficacy and safety
\n\u2022 support access to needed treatments for those with rare and life-threatening
\nconditions, and support democratic accountability and discussion in this process
\n\u2022 ensure the public interest in protecting the scope of the public health system –
\nincluding non-pharmaceutical therapies and treatments – from being diminished by
\nhigh drug costs
\n\u2022 protect against dangerous or unnecessary drugs
\n\u2022 support steps towards creating a national drug plan for all Canadians accompanied
\nby an appropriate regulatory regime.
\nWe believe that the government has successfully achieve a difficult balance regarding these
\nvalues in the provisions regarding access and cost in Bill 102.<\/p>\n
\n1) Widening availability of generic drugs. Previously brand name drugs had to be on
\nformulary for generic to be bio-equivalent and listed. Under this legislation generics can be
\nlisted without brand name drugs being listed. We believe that this could increase access to
\nbio-equivalent generics and lower costs without harming patients.
\n2) Widening what will be considered equivalent \u2013 e.g. under this bill, a pill and a tablet
\ncan be considered bio-equivalent. Previously only a pill and a pill could be considered
\nequivalent. We believe this could increase access to bio-equivalent generics and lower costs
\nwithout harming patients.
\n3) Conditional listings vs. Section 8 \u2013 Section 8 was an appeal used by doctors for
\ncoverage if a drug was not listed on formulary. There are no details about this in the
\nlegislation. We support the reduction of paperwork for physicians and the continued access
\nto drugs for patients who need them. We believe the outcome of this initiative depends on
\nwhat conditions will be placed before getting drugs on the listings. These must be
\nreasonably rigorous to protect patients while allowing people with serious illnesses to gain
\naccess to lifesaving drugs.
\n4) Elimination of rebates for pharmacies. Previously the government would pay
\npharmacies the cost of drugs charged by the manufacturers. But the manufacturers would
\ngive pharmacies \u201crebates\u201d as a way of getting them to stock their drugs \u2013 a kind of open
\n\u201ckick back\u201d. So the government was paying a higher cost for the drugs than the pharmacy
\nwas ultimately paying. This legislation proposes to eliminate the use of rebates and pay the
\nactual transaction price that the pharmacy pays for the drug. This will save government (and
\nthe public) money.
\n5) Dropping price of generics by 20% to 50% of brand name. Currently 1st generic on
\nmarket cost 70% of the brand name, the other generics cost 90% of the 70%. These were
\nmeant to be price ceilings but became floors. We believe this will reduce costs without
\nharming patients.
\n6) Decreasing the mark-up on drugs from 10% – 8%. We believe this will reduce costs
\nwithout harming patients.
\n7) Creation of best-practices prescription guidelines.
\n8) Increasing representation of patients on councils regarding the formulary. We support
\nthese initiatives with the proviso that adequate protections against influence of the drug
\nindustry are included. No patients, citizens or patient groups that are affiliated with, funded
\nby or otherwise supported by the drug industry should be allowed to sit in these positions.<\/p>\n
\n\u2022 Brand name drug companies argue that generic substitution is bad for health. They fund
\nand influence some patient groups and coalitions to put out this information. All major
\ncredible studies show this to be untrue.
\n\u2022 One other option is reference based pricing as in BC in which only the cheapest of a
\nclass of drugs is covered by the government plan. Patients wishing a more expensive
\nproduct must pay the difference. If there is a genuine medical need for the more expensive
\nproduct the government will pay for it in full. Studies in BC have never demonstrated any
\nadverse health outcomes from this policy.<\/p>\n
\n\u2022 Money being saved through the measures contained in Bill 102 should be invested in
\nhealthcare or social programs.
\n\u2022 The legislation creates an Executive Officer. The EO will have powers cabinet used to
\nhave to determine what is on and off the formulary. The EO will also negotiate deals
\nregarding price and bulk buying with drug companies \u2013 a role formerly not done by anyone
\nin the Ministry.
\nTo the extent that the creation of this position is motivated by a desire for the
\ngovernment to more effectively negotiate the price of drugs and use its buying power
\nto get the best possible value for Ontarians, we are supportive.
\nOn principle we believe that the decision about what is listed and not listed on
\nOntario’s formulary must be one that is accompanied by democratic accountability.
\nIn shifting the resposibility to determine what is listed to the Executive Officer, we
\nwould like to see clearly that the responsbility for the contents of the formulary
\nremains with our elected government. We would support additional initiatives to
\nensure that this Executive Officer operates with the maximum possible public
\ntransparency and the minimum possible influence of the drug industry.
\n\u2022 The section of the legislation relating to rapid review of breakthrough drugs may or may
\nnot be a good thing. It could just get more drugs that do not provide additional benefit on
\nthe formulary. This depends how rigorous the controls are. The need for rigorous protection
\nof patient safety and assurance of efficacy of drugs needs to be balanced with patient need
\nand demands for access to drugs in urgent cases and in cases of rare conditions.
\n\u2022 Some pharmacies are arguing that the reduced revenue for them resulting from some of
\nthe initiatives in this legislation will lead to closures of pharmacies in rural areas and in the
\nnorth. It is impossible for us to verify these claims without having access to their financial
\nreports. While we obviously support protecting access to pharmacies, if their financial
\nviability is based on “rebates” from the drug companies to stock their profits then another
\nsystem to ensure access to pharmacies would be more ethical and should be considered.
\n\u2022 Any additional initiatives to control the drug industry lobby would be positive, including
\nincreased democracy and transparency, reduced corporate donations to political parties,
\nand additional steps regarding drug company influence over physician prescription
\npractices.
\n\u2022 We support the Canadian Health Coalition\u2019s pharmaceutical strategy and encourage the
\nOntario government to advocate at the federal level regarding these initiatives. See More for
\nLess: A National Pharmacare Strategy at: http:\/\/www.healthcoalition.ca\/<\/p>\n