Dr. Akshay Jain
Clinical and Research Endocrinologist, Surrey, BC
Canada’s policy environment must improve to get innovative new medicines to the patients who need them.
Canada’s complex regulatory and reimbursement pathway means that patients must wait two years (732 days), on average, for access to approved new medicines through public drug plans — which puts us far behind peer countries including the U.S. and Germany (zero days), France (six days), Japan (22 days), Italy (128 days), and many others. While the median time for the Organisation for Economic Co-operation and Development to reimburse a drug after Health Canada approval is 368 days, in Canada it takes 710 days. This negatively impacts patient outcomes, strains our health systems, and makes Canada less attractive for future life sciences investments.
Mediaplanet spoke with endocrinologist Dr. Akshay Jain to learn how this failure to prioritize innovation affects patients.
How are new and innovative approaches to diabetes medicines changing the way patients manage their diabetes?
Newer medications not only help control elevated sugar levels but do so with low risk of causing low sugar episodes. Some also help with weight reduction, addressing the underlying root of diabetes progression. Similarly, some help reduce the risk of heart and kidney damage. These newer medications transcend boundaries from being merely glucose-lowering drugs to becoming comprehensive diabetes risk management drugs.
Do you have any examples of patients who have achieved glycemic control earlier on their treatment journey? What are the impacts when patients can reach this goal?
With appropriate education on lifestyle modifications and suitable medication selection, many of my patients are able to achieve glycemic control much earlier. Studies show that this can help reduce the risk of complications like blindness, kidney failure, amputations, heart attacks, and strokes down the line.
Do your patients who access their diabetes medicines through publicly funded programs lag behind those with private coverage in accessing newer treatments?
There’s significant heterogeneity in access when looking at public and private programs and also inter-provincial criteria for access to medications. Most medications become accessible through private coverage many months (sometimes years) before public plans cover them. Older diabetes medications covered on public plans also often have higher risk of side effects.
What are the consequences for patients with diabetes on public drug programs compared to patients with private insurance?
Although we don’t have long-term studies looking at how the disparity can affect complications, clinicians and patients often feel frustrated when some medications available in Canada that would be perfect for their situation cannot be used solely due to access limitations.
Are patients on public drug formularies aware that they may not have the same access to innovation as patients with private coverage?
Most Canadians are aware of this disparity. However, the general public has little knowledge regarding what factors are evaluated when public payers make decisions about which medications get coverage and which don’t. This lack of transparency also significantly affects clinicians’ ability to optimally make treatment decisions.
To improve patient access to new medicines, we must:
- Eliminate time between final Canadian Agency for Drugs and Technologies in Health (CADTH) recommendation and pick of file by the pan-Canadian Pharmaceutical Alliance (pCPA)
- Ensure the pCPA meets its own target timelines for completing negotiations
- Commit to listing products within 30 days of a completed pCPA negotiation
Together, we can minimize delays and ensure faster access to new medicines for Canadians.
This article was made possible with support from Eli Lilly Canada.