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Patient Access to Medications: Future of the Canadian Reimbursement Landscape Post-Event Blog

October 10, 2018

On Wednesday, September 26, 2018, the S2BN Toronto Chapter hosted our first 2018-2019 event, Patient Access to Medications: Future of the Canadian Reimbursement Landscape. This session focussed on pharmaceutical market access, reimbursement, and the proposed changes to the patented medicines pricing review board (PMPRB). To familiarize yourself with market access, please read the blog post from September 21, 2018 on the S2BN website. Before the start of the September 26th event, I sat down with the panelists for a brief informal chat about their educational backgrounds, career trajectories and their current professional roles.

 

Joan McCormick (Principal, Price Regulation Consulting, IQVIA)

 

Education and Career Journey

 

Joan McCormick obtained a B.Sc. in Life Sciences from Queen’s University. She has had an interesting and unique career trajectory ever since. Joan began her career working for Brogan Inc., a healthcare consulting start-up, and completed a part-time MBA while working. Joan has remained within the healthcare consulting field while the company she initially joined changed around her. Brogan Inc. eventually became IMS-Brogan through a merger, followed by another recent merger of IMS Health with Quintiles to form IQVIA.

 

She is currently a Principal in Price Regulation Consulting at IQVIA, a global company operating in 120 countries. Among its portfolios, IQVIA services pharmaceutical companies and other related stakeholders from pre-conception of drug development, to commercialization and loss of exclusivity. The market access division of IQVIA works towards helping drugs obtain listing on provincial formularies, performing data analysis to support payer decision-making, improving access to medicines through different payers, and handling real-world evidence and related regulatory framework. Joan has a niche role at IQVIA where she exclusively provides consultancy services related to Patented Medicine Prices Review Board (PMPRB).

 

Skills Critical for Success and Resources for Students

 

For students interested in pursuing consulting as a career, Joan highlights the importance of having a strong willingness to learn. She also listed organization, ability to multitask (as consultants work on multiple projects at any given time) and strong analytical skills as key for a successful career in consulting.

 

For those interested in learning more about market access and reimbursement, Joan recommends attending Market Access 101 – a day long event organized every spring by the Canadian Association for Healthcare Reimbursement (CAHR; https://www.cahr-acrss.ca/). The date for 2019’s Market Access 101 event has not yet been released; however, you can visit this webpage for information on what to expect and further updates: https://www.cahr-acrss.ca/page/MarketAccess1012018

 

Alex Chambers (Director, pan-Canadian Oncology Drug Review)

 

Education and Career Journey

 

Alex Chambers completed her undergraduate degree in Health Studies at the University of Waterloo, followed by a Master’s degree in Population Health at McMaster University. She has worked in the area of cancer care guidelines, as well as in health technology assessment (HTA) of medical devices at Health Quality Ontario. Alex joined the Canadian Agency for Drugs and Technologies in Health (CADTH) over 4 years ago and is currently the Director of the pan-Canadian Oncology Drug Review (pCODR) within CADTH. For more information on the structure of CADTH, read our blog post from September 21st, 2018.

 

As the Director of pCODR, Alex manages a team of 16 professionals with science backgrounds, oversees operations and scientific reviews performed by her staff, and works with the expert review committee that issues recommendations on oncology drugs for payers and other stakeholders.

 

Skills Critical for Success and Resources for Students

 

For students thinking of a career in health technology assessment, Alex advises students develop their skills in multitasking, problem-solving, innovative thinking and adaptability. Health technology and drug development is continuously evolving; hence, HTA professionals should be able to continuously evolve and adapt as well.

 

To learn more about CADTH, how they operate and what recommendations/reports by CADTH look like, visit https://cadth.ca/ .

 

Bennett Lee (Head, Market Access, Sanofi Genzyme)

 

Education and Career Journey

 

Bennett Lee obtained his BSc in Pharmacy from the University of Toronto, followed by a Master of Divinity from Tyndale University College & Seminary. Bennett began his career as a hospital pharmacist and then spent 10 years in government working at Ontario’s Ministry of Health and Long-term Care, where he held portfolios in policy development, primary care reform and managed a policy team. Bennett then transitioned into the private sector and worked at GlaxoSmithKline (GSK) as a Market Access Manager, followed by three years as the Director of Government Affairs, Market Access and Pricing at Teva Pharmaceuticals.

 

Currently, Bennett Lee is the head of Market Access at Sanofi Genzyme, a company that focuses on rare diseases, specialty care, immunology products and multiple sclerosis. In his role, Bennett manages a team responsible for determining the value of medicines to complete the clinical and health economic dossiers for submission to government agencies. Bennett describes his team as assisting in pricing and reimbursement of a product through strategic planning, harnessing value of a product and then communicating this value to government agencies, patient groups and other stakeholders (for more information on the market access process, see the S2BN blog post here).

 

Skills Critical for Success and Resources for Students

 

Bennett Lee believes students interested in market access and reimbursement roles should have a strong science background, an interest in business development and a general business acumen. Although an MBA is not required, students should focus on polishing their business skills. If you are interested in developing your business skills, you can attend S2BN events throughout the year and gain insight into the business side of the pharmaceutical industry. Other avenues of developing business skills include joining a student consulting association at your university, such as GMCA. Students at the University of Toronto can also enrol in the mini-MBA course.

 

There are multiple ways of charting your career path in market access – market access professionals usually start off in sales and marketing, data analytics or policy-based roles in government. Bennett himself followed the route from a role in government to market access in the pharmaceutical industry.

 

Summary of the Panel Discussion

 

The three panelists gave very informative presentations which led to a lively discussion with the audience. Joan McCormick discussed some of the proposed changes expected to come out of the PMPRB guidelines modernization process intended to lower drug prices in Canada. Two major changes are expected from the modernization process – removal of the countries with high drug prices and addition of countries with low drug prices as comparators, and taking the median price of a drug class as a comparator instead of using the highest price (as has been the case under the existing PMPRB framework). Moreover, PMPRB is now likely to consider pharmacoeconomics data and recommendations made by CADTH/INESSS in its decision-making. Joan talked about the negative impact of these suggested changes and noted this could increase the time between Health Canada’s approval of a drug and its commercialization. According to Joan, currently it is an “interesting and tumultuous” time for market access and reimbursement as the new PMPRB guidelines are expected to be released and put into effect any time now (keep an eye on the Canada Gazette II). 

 

Bennett Lee also voiced his concerns with the expected changes to PMPRB. He talked about the need for discovering new drugs to improve health outcomes. Developing a drug from the discovery stage to commercialization can take 8 – 10 years and cost as much as 2 billion dollars, which contributes to the high market price of drugs. Therefore, drug prices need to be fair enough to generate appropriate profit to incentivize companies to invest in the development of new drugs. This will become especially important as personalized medicine and advanced drug development technologies become a commonplace in the market. Bennett presented data showing that approximately 61% of new drugs launch in Canada and warned this number could decrease as drug prices are driven down with the proposed PMPRB changes. For example, New Zealand has very low drug prices; however, only 13% of all new drugs launch in New Zealand. Furthermore, regulations surrounding reimbursement and pricing that negate a profit incentive drove out pharmaceutical companies from New Zealand. Thus, even though drug prices are low in New Zealand, the access to life-saving innovations is limited. Therefore, the proposed PMPRB changes could affect availability of innovative drugs in Canada. Bennett also talked about other negative economic impacts of the expected PMPRB changes such as loss of investment in the Canadian pharmaceutical industry and associated jobs in Canada. Companies may choose not to develop drugs or launch innovative medicines in Canada if they feel they will not obtain reimbursement or achieve a reasonable list price. Bennett expressed uncertainty in the new PMPRB guidelines and how the pharmaceutical industry will react. He believes government agencies must work towards developing a more streamlined approach of value assessment and price review to ensure patients have access to innovative medicines that can improve their lives.

 

Currently, there is a lack of transparency with the new PMPRB guidelines and pharmaceutical companies are unsure of what to expect. The proposed changes may result in delayed access to new medications, interruptions in access of medications currently listed and decreased investment in Canada’s pharmaceutical industry, as it would take some time for the pharmaceutical industry to adjust and adapt to the new guidelines. Bennett stressed the price of drugs should be fair for patients and for companies looking to recoup their investments.

 

Alex Chambers provided insights into market access and reimbursement through the lens of a health technology assessment agency. She described the role of CADTH as determining the value of a drug by comparing it to other drugs that exist to treat the same condition. Alex provided details about the process undertaken by pCODR to determine the value of a drug. Currently, it takes 4-6 months for a drug to go through a review process by a multi-disciplinary team including pCODR reviewers, health economists, clinicians, patients and provincial drug plan managers. The pCODR expert review committee (pERC) first provides an initial recommendation, and then a final recommendation based on the feedback from the initial recommendation. Alex presented data highlighting Canada’s competitiveness among other developed countries in terms of time delay between regulatory approval and completion of health technology assessment. She also discussed some significant challenges faced by pCODR. These include the volume of submissions received, quality of clinical data which can impact economic models among other things, and a lack of direct comparison for drugs where there is no current standard of care. Alex also talked about finding efficiencies to deal with the volume of submissions and working concurrently with Health Canada to expedite the drugs approval and value assessment process.

 

All three panelists agreed that all stakeholders, including government and pharmaceutical companies, must work collaboratively to improve the commercialization and market access pathway and ensure Canadians have timely access to the newest innovative products at fair prices.

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