Sweeping changes in Ontario may impact all Canadians

People living in provinces outside Central Canada delight in accusing Ontarians of believing that what happens in Ontario affects the entire country – that Ontario is the “center of the universe.” This time, however, it could be true. Profound and innovative changes to the Ontario Drug Benefit Act could be the catalyst for policy changes throughout the country.

This is what happened. In April the Ontario government introduced Bill 102, Transparent Drug System for Patients Act, 2006. This Bill will overhaul the current Ontario Drug Benefits (ODB) program – a program that pays for prescription medication for Ontarians without private insurance and/or who are receiving social assistance. After extensive research and stakeholder consultation, Bill 102 had its first reading on April 13th. It proposes to:

• Improve patient access to drugs through conditional listings and rapid reviews of breakthrough drugs
• Ensure better value for money through changes to drug pricing and reimbursement
• Recognize the valuable role pharmacists play in patient care by paying them to provide enhanced patient counseling about the appropriate use of medications
• Invest in innovative health system research by establishing a fund to show that drugs produce positive outcomes in other parts of the system
• Reduce paperwork for doctors by replacing the cumbersome Section 8 process
• Strengthen transparency and accountability in the drug system by giving patients a role in drug listing decisions and appointing an Executive Officer of the Ontario public drug programs to manage the publicly funded drug system.

Several aspects of the legislation were welcomed.

• Inclusion of patients as full members on the new Committee to Evaluate Drugs - a committee that will recommend funding of new drugs.
• Creation of a Citizens Council, which will give the general public input into the public drug policies.
• A rapid review process for breakthrough drugs.

However there are concerns with the new legislation.

• The definition of what constitutes a generic or interchangeable drug was to change from “same as” to “same and similar” to the active ingredients and/or dosage.
• The definition of a breakthrough drug basically meant lifesaving. Quality of life was not included.
• A new position of Executive Officer (EO) was created. Most patient/consumers and stakeholder groups felt that too much power was given to this position without a clearly defined appeal process for “No” listing decisions. In a nutshell Bill 102 transfers the authority and responsibilities of the Health Minister for managing and overseeing the public drug system to an EO who will be appointed by the Lieutenant Governor in Council. The powers of the EO include for example: maintaining and publishing the Formulary, designating interchangeable products, listing and de-listing drug products, negotiating agreements with drug manufacturers and ensuring compliance with the legislation.
• The process to make the Bill in to Law was happening too quickly.

Other positive and negative aspects of Bill 102 also exist. Through continual dialogue with the health ministry, delivery of written submissions and oral presentation by the standing legislative committee, positive changes to the legislation resulted:

• Establishment of the Citizens’ Council in the legislation rather than leaving it for policies and regulations.
• Defining “similar active ingredient” and eliminating the pharmacist’s prerogative to interchange drugs for similar products.
• Clarifying that nothing in the legislation permits therapeutic substitution.
• Improving the transparency of Executive Officer and Drug Benefits program.

No matter how gratifying it is to know that the hard work made a difference, we must remain vigilant. The work is not finished. As Bill 102 goes into its third reading, work on policies and regulations begin. All stakeholders, especially patient/consumers, must stay alert and get involved. This legislation will eventually affect most Canadians. Bill 102 has the potential to influence the National Pharmaceutical Strategy as well as drug plans in other provinces. Click here to view Bill 102 then write to your MPs, MLAs and MPPs and let them know what kind of drug system important to you. For additional information, the Ontario Stakeholder/Industry Committee is hosting a meeting on July 6th to answer questions and take attendees through Bill 102 regulations and amendments. Click here for details.

Click here to view Bill 102