prescription drugs

Prescriptions written by U.S. physicians require a co-signature from a Canadian doctor before a Canadian pharmacist can legally fill them. It’s something Canada’s internet pharmacy industry needs, to survive. (iStock)

We've all heard horror stories about the skyrocketing cost of prescription drugs. There was outrage last September when a U.S. entrepreneur suddenly boosted the price of Daraprim, a life-saving anti-parasitic treatment, to a whopping $750 from $13.50.   And according to a recent Canadian survey by Angus Reid, more than 20 per cent of people said that they - or someone in their household - didn't take medicine as prescribed because of the cost. 

But help is on the way.

The Pan-Canadian Pharmaceutical Alliance (PCPA) was formed so that provinces and territories could negotiate prices for publicly covered drugs. The PCPA examines all drugs recommended for funding by two drug review panels. If they approve, one province takes the lead to negotiate with the drug manufacturer for one low price to be paid by all provinces. So far, they've saved more than a quarter of a billion per year by getting lower costs for 43 brand name and 10 generic drugs.  But they've got a lot of turf to cover. To me, the biggest question is why Canada pays much more for generic drugs than almost any other developed country.

The top reason is that more and more expensive drugs are getting approved and put on provincial formularies.  Two drugs - Sovaldi and Harvoni - are anti-virals that can cure (that's right, cure) hepatitis C.  The retail price for an eight to 24 week course of treatment is fifty-five to eighty thousand dollars.  Right now, ten provincial pharmacare programs have these drugs on formulary but will only provide them to patients with Stage 2 hepatitis C.  

At least a quarter of a million Canadians are infected.  For $20-25 billion, you could rid Canada of hepatitis C.  And that's just a couple of drugs for one disease.  There's a whole host of expensive drugs called biologics used to treat everything from rheumatoid arthritis to cancer - all of them very expensive.

There's something new on the horizon that will help stem the cost of expensive biologic drugs. Like other brand name prescription drugs, biologics have patents that expire.  Cheaper versions are coming.  In Canada, they're called Subsequent Entry Biologics. Other countries call them biosimilars and not generics because unlike generics, these drugs aren't made from the identical root chemical as the brand name.  The first in Canada is called Inflectra.  It's biosimilar to Remicade, a biologic used to treat Crohn's disease, psoriasis and arthritis.  Just over a year ago, the review panel I talked about gave Inflectra the thumb's up.  One thing about biosimilars is that unlike generics, the discount on brand name drugs is not so big.  Infectra's cost is $650 per 100 mg vial ; that compares $987.56 for a 100 mg vial of Remidcade.

Biosimilars aren't exactly generic drugs.  Unlike generics, they must be developed from scratch, which tells you why the cost is similar to the biologics they're intended to replace.  The process of making biosimilars is so complex that efficacy can vary from batch to batch. In the case of Inflectra, Health Canada approved it for rheumatoid arthritis and psoriasis, but not for Crohn's disease and ulcerative colitis. Biosimilars may or may not be interchangeable with biologics.  You might see a patient who takes a biologic and goes into remission only to relapse when switched to the biosimilar.  There are also questions about safety.  Biosimilars might be weaker or even stronger than biologics.  They might trigger an immune reaction.

For an excellent review, read this.

As for the prospects for a national pharmacare program, I'm of two minds. The previous federal government wasn't in favor of pharmacare but did call for cheaper generic drugs and more bulk purchases under the Pan-Canadian Pharmaceutical Alliance. The current federal health minister Dr. Jane Philpott has said that the focus of the new government is reducing the cost of prescription drugs before considering a national pharmacare program.  While not committing the government to pharmacare, she did acknowledge that studies have shown that a pharmacare program could save money.  

My reading:  don't expect to see any significant progress on national pharmacare in 2016. 

Brian Goldman is an emergency physician and the host of White Coat, Black Art. His latest book - The Secret Language of Doctors - is published by Harper Collins Canada.