Behind closed doors: Canada’s National Pharmaceutical Strategy

The National Pharmaceutical Strategy (NPS) is off to a shaky start. Two years of clandestine meetings have kept the Canadian public in the dark and stakeholders scratching their heads. Who are these people and what are they doing?

Past

The members of the NPS Taskforce have not been made public. For almost a year after the Ministerial Taskforce was struck in April 2004 to explore a National Pharmaceutical Strategy, no information about their work had been released to the public. Repeated requests for engagement fell on deaf ears. How can an NPS be successful without meaningful input from all stakeholders, including patients?

Eventually information leaked out. Initially we learned that the strategy would include nine priorities but the nine have since been narrowed to five focus areas. They are:

“Real World” drug safety and effectiveness Expensive drugs for rare diseases Drug pricing and purchasing Catastrophic drug coverage Common drug formulary In June 2005, nine months into their two-year mandate a call went out for input into one of the focus areas, “Real World” drug safety, and effectiveness. We were asked to provide our input on a survey. Unfortunately, the survey was not designed for the average Canadian; the questions were directed solely to researchers and clinicians. Patient organizations persevered requesting inclusion and were invited in September 2005 to the consultations on this focus area. The message we brought forward stressed that patients need to be included as equal stakeholders; we are the “real world”. They seemed to have listened, as the message was included in the meeting briefs. We have not been invited to consultations on the other four focus areas.

Present

The Taskforce was not heard from again until March 2006 and that was by accident. Best Medicines Coalition (BMC) unintentionally held a meeting at the same hotel where the NPS Taskforce was holding their closed meetings. Patient representatives from BMC (seized the opportunity and asked for an informal roundtable with the Taskforce. They declined, but Susan Patkau, Chair of the Taskforce, Wayne Lepine and Andrew Van der Gugten, NPS Project Task Group Co-chairs met with BMC to discuss their concerns. Interestingly, in April 2006, BC’s Better Pharmacare Coalition were also meeting with BC’s Health Minister and Mr. Van der Gugten regarding concerns about transparency and public engagement on this issue. Suddenly the Taskforce was scrambling to consult. What were to be “consultation” sessions were renamed “information” sessions that were held across the country with little advance notice. The session for Atlantic Canada was held in St. John’s, NFLD, the furthest and most difficult city to get to in the region on four days notice. This region is where 24-27% of the population has no protection for high cost prescription drugs. Certainly, NPS would be a priority here. The Deputy Minister of Health for NFLD questioned the wisdom of holding the session in NFLD if the purpose was to engage Canadians.

Future

The NPS Taskforce representatives have made it clear that their report to the Premiers, which is to be delivered on June 30, 2006, is only the beginning. They have said more dialogue with all stakeholders is planned. As far as the future is concerned, we really don’t know what will happen. We know the names of four members of the Taskforce; the other members remain a mystery. We know the Taskforces is examining NPS models from other countries. These models have produced poorer health outcomes in those countries. We need a Canadian made solution.

If you are content with the current state of Pharmaceutical policy in Canada, then stop reading this article now. It’s not for you. If you want a national pharmaceutical plan that has little interest in producing good health outcomes - an NPS that results in higher costs to the overall healthcare system for the long term, then sit back and do nothing. But if you believe like I do that this is Canada’s opportunity to get it right, then get involved. To produce these results, the NPS needs patient involvement and an open and transparent consultation process. Federal and Provincial bodies are developing the NPS. Contact your MLA or MPP and tell them that they need to get it right!