Canadian prescription drug costs surpass $18 billion

Dr. John Hoey, Editor Canadian Medical Association Journal 1867 Alta Vista Drive Ottawa, ON K1G 3Y6

Dear Dr. Hoey:

Dr. Steve Morgan’s commentary, and the accompanying editorial in the CMAJ of May 10, raised a number of questions regarding the value of innovative pharmaceuticals to the health care system.

We agree with Dr. Morgan’s call for “careful scrutiny” but with a caveat: drugs should never be viewed simply as a budget line item, nor be treated as commodities. Patients do not choose illness, but when disease strikes, they rightfully expect to have the best treatment available, be it medicinal or otherwise.

The broadest components of Canadian society have greatly benefited from the advances arising from the pharmaceutical industry’s research and development efforts. With respect to structural analogs in the same therapeutic class, it should be remembered that their varying characteristics provide the medical practitioner with alternatives to better meet individual patient profiles.

In order to ensure optimal use of medicines and achieve better health outcomes, Industry agrees that scrutiny of drug utilization and spending is necessary. Evidenced-based disease management and adherence to the proper therapy are cornerstones of best health care practices. With such a comprehensive approach, one may also consider whether additional drug spending can free up resources in other health care areas.

The suggestion that direct-to-consumer advertising in the U.S. is a significant cause of increased drug utilization in Canada appears anecdotal. More generally, a balanced discussion of direct-to-consumer advertising should take into account the view that well informed patients could gain a better understanding of their condition, and, ultimately, better treatment outcomes.

Figures published recently by IMS show for 2004 that the growth rate in drug store and hospital purchases of prescription and behind-the- counter medicines fell by 2.3 percentage points and the innovative component by 3.9 percentage points relative to the compound average of 11.9% for the years 2000 to 2004 . Should this decline be part of a downward trend, it is far from certain that it would be of net benefit to health care.

To deal with the many health care challenges today, scientists from industry, academia and regulatory agencies must resolve to work collaboratively. It has been suggested that to close the health care gap, for example, more work towards evidence-based health and disease management programs would be required. In pharmacovigilance, there is a need to develop risk assessment and risk management plans for medicines . Similarly, there is increasing demand for the development and application of methodologies for health outcomes and economics research related to medicinal therapies.

It is by fostering a more collegial relationship among scientists from the different sectors of health care that we can work more effectively to the benefit of Canadian patients.

Regards,

Jean Marion, Ph.D. Director, Scientific Affairs Canada’s Research-Based Pharmaceutical Companies (Rx&D)