Federal government | Patented Medicine Prices Review Board regulates prices of patented drugs in Canada by comparing them with the prices at which they are sold in 7 comparator OECD countries (some of which have the highest drug prices worldwide) and with the prices of other medicines in the same therapeutic class sold in the relevant Canadian market (6) | Change the comparator countries to include all OECD countries, or select a group of more diverse countries to better reflect true international market drug prices (6) | Decrease |
No regulation of generic drug prices | Individual provinces and territories have taken on this role (13), (14) by setting maximum generic prices at a percentage of the brand-name drug price | Decrease |
Alternatively, the mandate of the Patented Medicine Prices Review Board could be expanded to include regulation of generic drugs | Decrease |
Provincial/territorial governments | Limited negotiation with pharmaceutical companies to lower prices of generic and brand-name drugs | In 2012, the premiers committed to work together to bulk buy generic drugs to enhance collective bargaining power (15) | Decrease |
Alternatively, a national drug agency, with a single formulary, could negotiate drug prices more effectively | Overall decrease to both levels of government, but costs may shift to the federal level |
Variation in provincial/territorial drug plans and formularies, leading to inequity in drug access (9), (10) | Create a national drug agency, universal drug plan and single formulary | Increase, especially at federal level |
Variation in drug coverage for the working poor, whose copayment levels are high relative to their income | Implement different copayment systems:
| Increase |
| Increase |
Physicians | Lack of knowledge about drug prices (18), (24) | Improve physician knowledge of drug prices:
Provide price information in the form of a manual, (25) prescription template (26) or electronic prescribing system (27) Provide frequent feedback and reminders to be conscious of drug costs (25), (28) Encourage “step-up therapy”: if different drugs have comparable clinical effectiveness, start with the least costly one
| Uncertain, although the costs of an effective educational intervention could be offset by cost savings in drug expenses |
No routine physician–patient communication on the financial impact of prescribed medications (22) | Improve communication:
Increase awareness that drug expenses are an important barrier to access and that patients want to discuss this issue (22) Provide easily accessible information on drug prices to physicians, as a reminder of the financial impact of patient-borne expenses
| Uncertain, although the costs of an effective intervention to improve communication could be offset by cost savings in drug expenses |