New PMPRB report shows significant consistency in public drug plan coverage across Canada for drugs subject to "Common Drug Review" process

OTTAWA, ON, Feb. 22, 2022 /CNW/ - The Patented Medicine Prices Review Board (PMPRB) released today the third and final part in the Alignment Among Public Formularies in Canada series, which explores the current gaps and overlaps in Canadian public drug plan formularies.

This report compares formulary coverage across Canada's public drug plans for 307 medicines reviewed by the Canadian Agency for Drugs and Technologies in Health (CADTH)'s Common Drug Review (CDR) process between December 16, 2003, and June 30, 2019. The analysis also looks at listing and agreement rates in specific market segments, including biologic and small molecule medicines, single- and multi-source medicines, and expensive drugs for rare diseases.

The findings from this report show that reimbursement for CDR-reviewed medicines is fairly consistent across most of Canada's public drug plans. Individually, provinces listed an average of 65% of the selected medicines and 88% when corresponding sales were factored in, which indicates that the medicines not covered by the plans accounted for only a small share of national sales. These listing rates varied only slightly across the market segments analyzed. Most notably, with the exception of a few smaller public drug programs, listing rates for expensive drugs for rare diseases were higher than those for other CDR medicines.

Quick Facts

• Many of the CDR-reviewed medicines selected for this study were listed on most public formularies, with drug plans listing an average of 65% of the selected medicines.
• The average listing rate increased to 88% when weighted by sales, which indicates that the medicines not covered by the plans accounted for only a small share of national spending.
• Of the 307 selected medicines, 207 (67%) were listed in six or more provinces and accounted for 90% of sales.
• Agreement rates for listings across public formularies were substantial, at an average of 81%, and increased to 91% when sales were factored in.
• The average listing rate for biologic medicines was slightly higher than for their small molecule counterparts, but the average agreement rate across provinces was slightly lower.
• Coverage rates for multi-source medicines, which include generics and biologics with available biosimilars, surpassed those for single-source medicines in almost all public drug programs, while their interprovincial agreement rates were almost identical.
• Expensive drugs for rare diseases (EDRDs) had higher listing rates than other CDR-reviewed medicines in most of the larger public drug plans.

Associated Links

Alignment Among Public Formularies in Canada, Part 3: Medicines Assessed by the Common Drug Review

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SOURCE Patented Medicine Prices Review Board

Contacts: PMPRB Media Relations, [email protected]