The Canadian province of Quebec's decision to set a maximum price for an entire class of medicines has been attacked as "dangerous."
On the advice of NESSS, the province's health services review agency, a maximum payable price (MPP) of C$0.55 will be payable for the full range of proton pump inhibitors (PPIs) provided by Quebec's public prescription drug insurance plan starting October 1, Health Minister Rejean Hebert has announced. The move has been condemned by Canada's Research-Based Pharmaceutical Companies (Rx&D), which says it is interfering in the doctor-patient relationship and is likely to increase healthcare costs rather than reduce them."By establishing an MPP, many of the 200,000 patients affected will face the difficult choice of maintaining their current therapy by paying the difference between the price of their medication and the amount reimbursed by the Minister, or switching to a different medication that may result in a different response as well as possible side-effects," warn PhRMA president Russell Williams and Claude Perron, president of the industry group's Quebec committee and general manager of Shire Canada Inc.
The decision is political and sets an important precedent, by restricting the choice of doctors and their freedom to prescribe the medications that, according to their clinical judgement, are the most appropriate for each of their patients, they say. "The sole reason given for this decision is to generate savings that will likely be offset by additional medical appointments and increased pharmaceutical advice."
Williams and Perron also point out that third-party payers often disregard the fact that each patient reacts differently to prescription medications. They urge the Minister to publish the impact analyses carried out by his Ministry to justify this decision, and point to a study by the Canadian Health Policy Institute which showed that while a similar approach adopted for PPIs by in British Columbia had made savings to the drugs budget, overall healthcare costs had increased more than C$43 million because of proven therapeutic inefficiency and serious side effects. They also note that public spending for this type of medication in Quebec has dropped 25% since 2008.
They go on to deplore the fact that the Minister's decision offers no solution to "the real challenge," which they say lies in intensifying efforts aimed at the optimal use of medication. "We believe that it would have been preferable to discuss the issue of PPI in a collaborative context between the government of Quebec and the affected manufacturers, a partnership which would have opened the door for more appropriate solutions for Quebec as a whole,” they say.
Pfizer Canada Inc's president, John Helou, also warns that the decision will have broad negative implications for Quebec doctors and their patients.
"What this new policy really does is remove vital decision-making powers about the medicines patients get from doctors to bureaucrats. It will force pharmacists to give patients the drug the government wants them to have, not the one their doctor wants them to have or knows will work best for them," he writes, in a letter published in The Montreal Gazette.The new regime "is a dangerous precedent in Quebec history and a slippery slope," and it represents "a new low of putting cost savings ahead of patient welfare and physician authority in treatment decisions," Mr Helou writes, adding: "for patients, the choice between medicines can be crucial, making the difference between a therapy being tolerated and effective or not."
The Rx&D leaders also warn the Quebec government that "proceeding without consultation and in such a hasty manner...constitutes yet another harmful measure for the entire pharmaceutical research sector and sends a contradictory message from a government that says it wants to promote and develop a centre for excellence in pharmaceuticals."