Once Health Canada has approved a drug for use in Canada, the country’s public drug plans must decide if the drug will be eligible for public reimbursement. The CADTH Common Drug Review (CDR) plays an important role in their decision-making processes.
Through the CDR process, CADTH conducts thorough and objective evaluations of the clinical, economic, and patient evidence on drugs, and uses this evaluation to provide reimbursement recommendations and advice to Canada’s federal, provincial, and territorial public drug plans, with the exception of Quebec.
Reviews are undertaken for new drugs, as well as existing drugs approved for new indications. To shorten the time between Health Canada regulatory approval and a CADTH reimbursement recommendation, a CDR application may be made while a drug is still being reviewed by Health Canada; however, the CADTH drug reimbursement recommendation is not issued until Health Canada approves the drug for use in Canada.
A Pan-Canadian Process
Until 2003, each drug plan conducted its own drug reviews and decided independently which drugs it would pay for, with input from different expert groups. Differences in drug evaluations sometimes led to differences in reimbursement decisions.
The CADTH CDR process was introduced by health ministers in 2003 to replace the 18 independent review processes that existed in different jurisdictions in Canada. The consolidation of drug reviews under CADTH established a pan-Canadian approach and has led to:
- greater efficiency and reduced duplication of effort
- enhanced consistency of drug reviews across Canada
- equal access to timely, evidence-based information and expert advice for all participating jurisdictions
- an ability to harness expertise from across the country
- the creation of a consistent and transparent process for collecting input from patients.
Considering the Evidence
In formulating its drug reimbursement recommendations, CADTH analyzes studies that report on the clinical effectiveness, safety, and cost-effectiveness of the drugs under review. Drugs are compared with current accepted therapy to determine the therapeutic advantages and disadvantages of the new drugs, as well as the cost-effectiveness of the drugs in comparison to current therapeutic options.
In addition to the clinical and economic evidence, the CDR process takes into account input by patients, drug manufacturers, and clinicians. CADTH notifies patient groups at the outset of a CDR review and invites them to provide input. This step in the process captures patients’ experiences and perspectives of living with a medical condition for which a drug under review is indicated, their experiences with currently available treatments, and their expectations for the drug under review.
Reimbursement recommendations are made by the CADTH Canadian Drug Expert Committee (CDEC) — an appointed, independent, pan-Canadian advisory body comprised of individuals with expertise in disease management, drug evaluation and utilization, and health economics. The expert committee also includes public members.
Participating drug plans make their final reimbursement and coverage decisions based on the CADTH recommendations and other factors, such as drug plan mandates, jurisdictional priorities, and budget impact.