Communiqué - Provincial and territorial health ministers



    TORONTO, Sept. 4 /CNW/ - Provincial and territorial health ministers met
today in Quebec City to discuss access, quality, and safety issues in
sustaining their publicly funded health systems.
    Ministers are disappointed by the lack of commitment by successive
federal governments on the National Pharmaceuticals Strategy and the missed
opportunity to deliver Canadians with protection against catastrophic expenses
and support for people with rare diseases. The provinces and territories
remain committed to this important issue and look forward to seeing the
federal government fully engage as equal partners in the weeks and months
ahead.
    Quebec has its own pharmacare program and consequently, is not part of
the development of the National Pharmaceuticals Strategy. Quebec is however
open to sharing information and best practices.
    Ministers talked about their progress and common interests in better
access to health services and affordable drugs, pandemic preparedness,
e-health, and Fabry's disease research. They also emphasized the importance of
health promotion, and chronic disease prevention and management in improving
the health of Canadians.
    All these issues require significant funding. Ministers share the
expectations of Canadians that the federal government will be a full funding
partner in advancing these issues.
    "Provincial and territorial ministers are looking for commitments and
action from the federal government on the key issues we discussed today," said
Prince Edward Island Health Minister Doug Currie, chair of the
Provincial-Territorial Conference of Ministers of Health.
    Beginning in 2009, ministers will host a series of forums with
governments, experts and stakeholders to advance collaborative work towards a
sustainable health system that delivers excellent care at affordable cost.
    "These forums will build on the efforts of individual provinces and
territories to improve their health systems," said Minister Currie.
    Provincial and territorial ministers are troubled by the current listeria
infections and will continue to work with the federal government in the review
process.
    Ministers meet with federal health Minister Tony Clement tomorrow.


    
    NATIONAL PHARMACEUTICAL STRATEGY
    DECISION POINTS

    EXECUTIVE SUMMARY:

    Overview:
    ---------
    
    To date, the federal, and provincial and territorial (F/P/T) governments
have individually made significant efforts to address the challenges and
manage pharmaceuticals in a way that maximizes patient health outcomes while
contributing to system sustainability. However, as the responsibility for many
aspects of pharmaceuticals in Canada is shared among jurisdictions, there are
interdependencies and limitations with respect to what individual
jurisdictions can achieve on their own.
    Recognizing the growing importance of pharmaceuticals in health care, and
the cross-jurisdictional nature of the issues, in September, 2004 First
Ministers directed Health Ministers to establish a Ministerial Task Force
(MTF) to develop and implement the National Pharmaceuticals Strategy (NPS) as
part of the 2004 10 Year Plan to Strengthen Health Care. All Health Ministers
(with the exception of Quebec) were included in the MTF under the
co-chairmanship of the federal and British Columbia Ministers of Health.
    On September 21, 2006, P/T Ministers of Health released the NPS Progress
Report to the public with endorsement of the federal Health Minister. On
December 9, 2006, F/P/T Ministers of Health agreed to proceed with Phase II of
the NPS, and to fund this next phase of work ($2.937M Jan 07/March 08).
    The purpose of the NPS is to address the challenges and opportunities
across the drug life cycle using an integrated, collaborative, multi-pronged
approach to pharmaceuticals within the health care system.
    Quebec, having its own pharmacare program, is not part of the development
of the National Pharmaceuticals Strategy. Quebec is however open to sharing
information and best practices.

    
    Catastrophic Drug Coverage (CDC)
    --------------------------------
    
    Catastrophic Drug Coverage (CDC) is the area within the NPS that has the
broadest public interest. CDC is fundamental to the First Ministers agreement
that "no Canadian should suffer undue financial hardship in accessing needed
drug therapies." It was this agreement that led to the direction to develop
and implement the National Pharmaceuticals Strategy.
    In keeping with this principle, there is a need to establish a national
minimum standard of pharmacare coverage for Canadian citizens which recognizes
and retains provincial and territorial jurisdiction and autonomy over
pharmacare program delivery and design.
    Currently provinces and territories either do not have resources to
establish pharmacare programs, or face significant fiscal challenges
maintaining existing catastrophic prescription drug coverage. With significant
cost growth in this area, provinces are increasingly being forced to
reallocate resources from priority areas, including education, other health
programs and public infrastructure to sustain coverage.
    P/Ts are of a common view that Catastrophic Drug Coverage is as essential
to Canadians as physician and hospital coverage, the latter two of which are
subsidized by the federal government. Accordingly, P/Ts believe that the
federal government has a funding responsibility to establish a minimum
standard of drug coverage for all Canadians.

    
    Decision sought: to establish a funding formula that supports a national
    standard of pharmacare coverage for all Canadians and:

    -   protects the flexibility and autonomy of provinces and territories to
        define program design to best meet the needs and economic realities
        of their respective populations;

    -   is based on the principle that provinces/territories will introduce
        and/or maintain pharmacare coverage where, on average, prescription
        drug costs will not exceed 5% of the net income base for their
        respective populations;

    -   recognizes the federal government's role and responsibility as an
        equal partner (50/50) in funding provincial and territorial coverage
        consistent with the standard - the estimated cost (2006) is $5.03B
        ($2.52B federal/$2.52B P/T)

    Expensive Drugs for Rare Diseases (EDRD)
    ----------------------------------------
    
    Public drug programs are challenged by rare disease therapies. Despite
low numbers of patients affected by rare diseases, the high per patient costs
and limited available evidence establish precedence for what governments are
willing to accept in establishing how public funds are used and prioritized.
    Jurisdictions want to work together to achieve more consistent access;
however, collaborative efforts introduce complexities and difficult policy
questions about how to subsidize patients across health systems and establish
appropriate public accountabilities.
    There are public expectations to take immediate action to improve
collaboration and access for patients affected by rare disorders in Canada.
The current system is not perceived to be addressing the unique medical needs
and circumstances of vulnerable patient populations affected by rare diseases.
There is potential migration of patients with rare diseases to those
jurisdictions that may offer access and coverage to certain rare disease
therapies.
    A proposal to implement a Canadian Access Program for Rare Diseases has
been developed.

    
    Decision sought: to establish a Canadian Access Program for Drugs for
    Rare Diseases

    -   Rare diseases defined as a primary hereditary metabolic single-gene
        disorder (with a prevalence of less than 1.65 per 100,000 CDNs) that
        is life threatening or severely debilitating, and with a primary
        treatment available

    -   Access based on participation in research and monitoring

    -   Pool expertise and funding (based on 50/50 F/P/T funding formula)
        with centralized, transparent decision making model with public
        involvement.

    Common National Formulary (CNF)
    -------------------------------
    The underlying principle is that as CDR reviews a broader scope of drugs
and provinces adopt these recommendations on a consistent basis that
jurisdictions will become more similar over time.

    Agreement sought: to recognize the intent of this objective has been met
    through the establishment and adoption of the Common Drug Review (CDR)
    process. There is greater than 90% commonality on what provincial
    jurisdictions pay for.

    Pricing and Purchasing (P & P)
    ------------------------------
    
    A series of reports have noted important price variations within the
Canadian non-patented drug product marketplace. Governments are working
together, where possible, to develop approaches that will extract additional
value for this sector of the pharmaceutical marketplace for the public.
    It is important to balance the implementation of pricing approaches with
the need for a transparent, accountable system and viable supply and
distribution chain that can meet the needs of Canadian patients and at the
same time correspond with jurisdictional economic strategies.

    
    Agreement sought: to recognize a national approach to achieve pricing and
    purchasing savings is not realistic at this time given the ecomonic
    development and legislative/policy considerations within individual
    jurisdictions. Interprovincial collaboratives should be separately
    pursued and evaluated outside of the NPS.

    Real World Safety and Effectiveness (RWSE)
    ------------------------------------------
    Work on the RWSE activities has progressed to the point at which both the
business plan and the proof-of-concept for the Drug Effectiveness Safety
Network (DESN) are ready for release. The Federal government considers this
area to be of the most importance for the Canadian public.

    Agreement sought: to support a federally-funded RWSE program, provide
    access to necessary data and identify priority drugs for monitoring.
    





For further information:

For further information: Media Inquiries: Darlene Gillis, Department of
Health, Prince Edward Island, (902) 314-3128

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