| Summary: | Canada adopted guidelines for the economic evaluation of pharmaceuticals in 1994, and a central process for drug assessment in 2003. The context and the way the issue reached the agenda in the two time periods differed. The guidelines were adopted amidst growing academic interest in methods for economic evaluation of pharmaceuticals in Canada and internationally, and were first promoted by an entrepreneur from the pharmaceutical industry. The Common Drug Review (CDR) was adopted in a context of broader intergovernmental negotiations over health reforms, and came onto the agenda as a policy option that addressed pharmaceuticals but avoided the fraught question of public insurance. Both processes aim to harmonize drug assessment in Canada and ensure that publicly reimbursed drugs are cost-effective. Neither is the subject of legislation or regulation, but the CDR enjoys greater uptake as a result of an intergovernmental agreement that all new drugs will be subject to its review. Evaluation of the CDR has been more robust, and finds a split in opinion among stakeholders concerning the CDR’s benefits. This article describes the reforms using information drawn from government and CCOHTA/CADTH documents, published reflections of participants and secondary literature, and nine expert interviews. It finds that although the CDR’s design and implementation respond to some of the shortcomings of the Canadian guidelines, there are still important unresolved tensions between harmonization and transparency in drug assessment, and new challenges regarding pharmaceutical pricing and use of evidence. The way these tensions are resolved has important implications for broader attempts to reform public drug coverage in Canada.
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