Legal proceedings, repeated delays, resounding resignations: if the reform aimed at reducing the price of drugs in Canada were an action film, we could say that the screenwriter gives us what we pay for.
Such twists and turns would be entertaining if they didn’t touch on such a crucial issue: Canadians’ access to reasonably priced drugs.
Today, after six years of an interminable saga, the Trudeau government must deliver to the people what it promised them: real and substantial price reductions.
But it must also draw lessons from the fiasco we are witnessing. In-depth reflection is required.
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Let’s go back. In 2017, the Trudeau government finds that Canadians are paying far too much for their drugs. On the planet, only Americans and Swiss pay more.
He therefore promises reform and savings of 13 billion over a decade.
It is the Patented Medicine Prices Review Board (PMPRB), a federal body responsible for setting ceiling prices for drugs, which is piloting the file.
The PMPRB is birthing a reform. But it was torpedoed in court by both the industry and by Quebec, which saw it as an encroachment on its areas of jurisdiction. Entire sections of the reform fall. The promised savings drop to 3 billion.
The reform thus butchered must come into force in July 2020. But citing the pandemic, the federal government backs down and postpones it for six months. At the time, no one was fooled. The federal government does not dare to alienate pharmaceutical companies as it fights to obtain vaccines against COVID-19.
Six months later, the Trudeau government announces a further six-month postponement. Then another. And yet another. If you calculate correctly, that’s two years late.
Last July, the reform finally came into force. End of the story ? That no ! Guidelines must be developed to articulate it. And these ignite the powder.
The industry is fighting hard and dissensions are appearing within the PMPRB itself. Last December, its interim president, Mélanie Bourassa Forcier, slammed the door.
One of the three other members of the Council, Matthew Herder, also resigns. Then it’s the general manager’s turn.
Action, you say?
Surprisingly, the two PMPRB resignations who explained their actions put forward diametrically opposed reasons.
Matthew Herder essentially accuses the government of giving in to pressure from the pharmaceutical industry and not supporting reform1.
Mélanie Bourassa Forcier asserts on the contrary that the PMPRB did not respect its obligation to consult the “stakeholders”, including the industry. She denounces a “dialogue of the deaf”2.
The federal Minister of Health, Jean-Yves Duclos, tells us hard work to replace the resigning members of the PMPRB and for the reform to move forward.
Very good. We must actually bring this damn reform to a successful conclusion once and for all.
But neither can we pretend that the process is a long calm river and simply fill vacancies with a whistle. The reflection must go much further.
The current saga shows how difficult it is to deal with the pharmaceutical industry. Faced with the prospect of price cuts, it has outright threatened to deprive Canadians of certain drugs. This is heinous blackmail.
The question is how to answer it.
The government must see if it backs the approach of Matthew Herder, who argues that Big Pharma must be stood up to with more conviction.
Or if he adopts the one advocated by Mélanie Bourassa Forcier. In her letter of resignation, she asserts that nothing will be achieved by direct confrontation. She argues that the price of drugs, their access and the investments in research made by pharmaceutical companies are related issues that should be tackled together.
Above all, the idea is not to give in to pharmaceutical lobbying, especially since we know what their promises are worth. In the 1980s, industry promised to invest 10% of its revenues in research in Canada in return for a favorable patent regime. She hasn’t kept her part of the pledge for a long time.
But we must seriously examine whether, as Ms.me Bourassa Forcier, we can get more from the industry – and with binding commitments, this time – thanks to a more collaborative approach.
The current fiasco forces us in any case to shake up the status quo. We even have to wonder if the PMPRB, which has just practically imploded before our eyes, is the right structure to extract the maximum benefit from the pharmaceutical companies. The mandate of this organization is essentially limited to setting price ceilings for drugs.
One thing is certain, the evil that plagues the overhaul of drug prices will not be resolved with a small pill. The time has come to resort to great remedies.