Transparent Drug System for Patients Act, 2006

Questions and Answers

What is the purpose of this legislation?:

If passed, this legislation will enhance Ontario's drug system to :

  • ensure that patients get better access to the drugs they need,
  • that taxpayers get value for the money they spend, and
  • that drug companies are fairly compensated for the money they spend on critical research and innovation.

Why is Ontario doing this now?

  • Ontario has one of the most generous drug coverage plans in Canada. Drug costs have been rising and are a threat to our entire public health care system. We need to ensure consumers continue to have access to the drugs they need at reasonable prices.
  • Ontario's health care system provides a competitive advantage for Ontario's employers and a compelling reason to invest here. The rising costs of drugs affects employer drug plans and the ability to keep Ontario competitive with other provinces and countries.
  • The legislation will allow changes to bring provincial and employer drug plan costs under control, and ensure the sustainability of our drug coverage.

How will patients benefit from these changes?

  • Patients will have improved access to drug treatments at better prices.
  • A proposed new conditional drug listing will mean new drugs could be conditionally listed for a specific time while appropriate use and price negotiations occur between Ontario and the drug company.
  • A faster review process for breakthrough drugs is also proposed for life-threatening illnesses.

Will this affect coverage or eligibility for Ontario Drug Benefit plan or Trillium Drug plan recipients?

  • No. There are no cuts or additional costs for drug benefit recipients. Co-payments will not increase.
  • There will be no change to provincial drug program eligibility.

Will this put drug company investment in Ontario at risk?

  • No. Our plan is a balanced approach that will not impair the ability of drug companies to make money in Ontario.
  • The money that drug companies spend on research and innovation is money well spent. We will make sure they are fairly compensated for those investments.
  • We are taking a balanced approach that will see all parts of the marketplace contributing to the solutions, and all parts benefiting from those solutions as well.

Will this put Ontario's pharmacies at risk?

  • Ontario will continue to be a profitable marketplace for pharmacies.
  • We recognize the critical role that pharmacists can play in patient care, and are enhancing their role
  • There are changes here that will increase pharmacy revenue. We are increasing the dispensing fee. We will be looking at payment for enhanced pharmacy services and better utilizing the professional skills of Ontario's pharmacists in medication management and chronic disease management. We also continue to support the important role of pharmacists in primary care through Family Health Teams.

What is the government's plan to improve the drug system?

  • The passage of this legislation would allow the implementation of a plan that will improve Ontario's drug system. It will mean savings that can be reinvested in the drug system. It would :
    1. Improve patient access to drugs by :
      • Introducing a Conditional Listing category that would allow patients to access new drugs on a conditional basis while its evaluated for a formal listing
      • Making rapid funding decisions for breakthrough drugs for life-threatening conditions
      • Introducing equity into the system by aligning all of Ontario's publicly-funded drug programs so that the same rules of access apply everywhere
      • Moving towards the elimination of restrictive listing categories like Limited Use and Inh4idual Clinical Review (Section 8) that burden patients and doctors with administrative hurdles and impede access to needed drugs
      • Creating an Exceptional Access mechanism that would work as a safety valve for certain patients when they can't access a drug in any other way
    2. Ensure better value for money by :
      • Paying less for generic drugs by changing the pricing structure
      • Negotiating more competitive prices for brand name drugs
      • Working to develop chronic disease partnerships with brand name drug companies
      • Increasing the fees paid to pharmacies to dispense drugs to better reflect the true costs of dispensing
      • Removing the hidden rebates paid to pharmacies
      • Enforcing drug pricing compliance from manufacturers which will protect pharmacists from unauthorized price increases
      • Allowing greater interchangeability of brand and generic drugs
    3. Promote the appropriate use of medications by :
      • Paying pharmacists for providing direct patient care services like medication management reviews, in recognition of their value as front-line health care providers
      • Developing web-based, independent, best practice guidelines to ensure the right drug for the right person at the right time. This Shared Care Network would help doctors make the best prescribing decisions and help patients adhere to their drug therapies
    4. Invest in innovative health system research by :
      • Establishing an Innovation Research Fund to support drug policy by investigating the value of medicines across the entire health care system
    5. Strengthen transparency and accountability by :
      • Establishing formal governance principles to improve transparency and accountability
      • Appointing an Executive Officer to manage the publicly-funded drug system, including making listing decisions, publicly communicating listing decisions and working more closely with stakeholders
      • Giving patients an active role in drug listing decisions by appointing two patient representatives to the renamed Committee to Evaluate Drugs (formerly Drug Quality and Therapeutics Committee)
      • Creating a Citizens' Council to give the public an opportunity to guide public drug policy
      • Forming a Pharmacy Council to help develop policy and reimbursement models for pharmacists
      • Generating more transparency by publicly reporting on the status of drug reviews as well as the work of the Committee and Councils

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