Moving experiences

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Speeches

Improving Patient Outcomes The Role of Medicines and the

Innovative Pharmaceutical Industry in An Integrated Health System

Speech by Jean-François Leprince, President, Aventis Pharma, Chairman, Canadas Research-Based Pharmaceutical Companies, (Rx&D)

College papers on Moving experiences

OTTAWA (April 4, 00) Thank you Commissioner Romanow (and members of the Commission?) for allowing us to present our views on the future of health care in Canada. My name is Jean-François Leprince and I am President of Aventis Pharma and Chair of the Board of Directors of Rx&D. With me today is Murray Elston, President of Rx&D, the national association representing over 1,000 employees who work for Canadas 6 research-based pharmaceutical companies.

While several proposals are being put forth on the future of health care in this country, we are of the firm opinion that patient health outcomes should be the paramount consideration in the development of government health policy and the delivery of health services. We also believe that an effective solution to the issues facing our health care system in Canada must include measures to ensure that effective medications are accessible to patients and then used appropriately to achieve optimal health outcomes.

Innovative medications, when used appropriately, have been proven to prevent illness, effectively treat disease, improve quality of life and manage patient care outside of institutional settings. It is often the case that innovative pharmaceuticals help avoid hospital admissions and shorten hospital stays. Once patients are moved out of hospitals, however, their medication costs become an expense to either an insurer or themselves. This interface between hospital and community care can be problematic for patients, from both a clinical and an economic perspective. We believe there should be a seamless continuation of pharmaceutical therapy between these care settings, as unnecessary changes in treatment, often due to drug plan restrictions, can result in adverse health consequences for patients, and avoidable costs for the health care system.

Given the importance of medications, Rx&D believes that they should be considered a medically necessary component of the health system. There should be adequate coverage programs in place to ensure all Canadians have access to necessary innovative prescription medicines. This access should not be dependent on geographic location, age, gender or wealth. It should be up to health service providers, in discussion with patients and on a case-by-case basis, to determine whether pharmaceutical treatment is medically necessary. It is important to bear in mind that an individuals response to medications is unique in terms of effectiveness, side effects, compliance, and other measures. While it is a fact that large studies are undertaken to demonstrate the relative safety and efficacy of innovative medicines, the real test occurs when the individual is receiving the therapy. For those who do not respond as anticipated, it is imperative that other therapeutic options are available.

Advances in pharmaceutical therapy have a direct and measurable effect on the health of individuals and populations. New medications are approved for use in Canada only once they have been proven safe and efficacious. We must all commit to improving the use of these approved medications in patients that will benefit from them. The over-, or under-use of proven therapies has undesirable health and economic consequences and compromises our ability to achieve their full potential value. We refer you to the compelling examples of asthma and cardiovascular disease cited in our written submission to the Commission. Integrated efforts must be undertaken to promote and assure optimal drug therapy, including the involvement of physicians, pharmacists, other health professionals, payers, innovative pharmaceutical companies and, of course, patients themselves.

Education is a critical component of optimal medication use, as are monitoring systems to provide information and feedback on the effectiveness of treatment. Rx&D believes that to improve decision-making and to achieve an accountable, integrated health system, the government needs to encourage a disease management concept that relies on evidence-based, outcome-oriented performance indicators.

Less attention should be paid to administrative barriers such as reference-based pricing that are implemented solely to control drug plan costs rather than ensure optimal patient care. Evidence from reference-based pricing studies in Europe indicates that such policies do not control pharmaceutical costs over the long term. Norway abandoned the practice after concluding that the cost of running the program exceeded the savings on medicines. We include numerous examples, in our written submission, of peer-reviewed studies on reference-based pricing that clearly state the pressing need for more research to understand the full impact of such programs. To summarize, the effects of reference-based pricing on the use and cost of other health services, the administrative burden to physicians and pharmacists, and most importantly, the health outcomes of patients, have yet to be adequately analyzed. A systematic evaluation of reference-based pricing is therefore essential before such a policy is further endorsed.

Disease management programs have been shown to be effective strategies for optimizing patient care, and hold promise as one of the keys to ensuring the sustainability of our health care system. Such programs take a broad view of health management with a view to improving patient health outcomes while, at the same time, reducing the economic burden on society as a whole. They are centered around multidisciplinary, patient-focused approaches to implement best practices in the prevention, diagnosis and treatment of disease, and can result in significant benefits for individual patients and society at large. Such health management programs cannot be successfully approached in a piecemeal fashion, but must include the committed participation of all key stakeholders. We refer you to our written submission for examples of such programs, and studies demonstrating their benefits.

The Commission has seen evidence that medications are a growing portion of total health care costs. However, it is important for the Commission to recognize that patented prescription medicine costs account for less than 6 cents for every dollar spent on national healthcare. And though spending on pharmaceuticals is increasing, it is also important to understand that it is the utilization of medications and the aging of the population that is behind this trend. Provincial governments currently spend two-thirds of their drug budgets on patients over 65 years of age. And the governments own studies have shown that annual price changes of medications do not play a significant role in driving expenditures. In fact, prices of patented medicines have shown an average annual decrease since 188.

We must all recognize the global natures of the economy and health. The innovative pharmaceutical industry operates within a world market, and makes a substantial contribution to both health and the economy. With current Canadian government initiatives focused on both health and innovation, Rx&D is in a key strategic position to contribute to both agendas. The private business sector remains the largest single contributor to health-related research and development investment in Canada. We employ a highly educated workforce and support nearly 5,000 direct academic positions. Our companies invested approximately $1 billion in research and development in Canada in 001.

The Canadian and provincial governments, as well as our citizens, will continue to benefit from the contributions of the pharmaceutical industry so long as government policies take into account the interrelationship between industrial and health policy.

As we move forward, cooperation and partnerships to encourage the development and use of medications that will enhance the lives of Canadians must be sought. The human genome project promises to unlock a myriad of secrets about disease, prevention and treatment, and we should pursue this knowledge in a cooperative venture to ensure the information is used ethically and wisely.

Rx&D is fully prepared to partner with the federal, provincial and territorial governments, as well as other health care stakeholders, to implement the necessary reform and create the best health care system for Canadians. In doing so, we need to be turning our collective attention to supporting the development of new innovative medicines and ensuring their appropriate use to achieve the best possible patient outcomes. Encouraging innovation, removing access barriers to proven therapies, monitoring the outcomes of medication use, and keeping the patient at the focus of all these efforts are all principles worth pursuing in our quest to provide the best health care for the most people at the best cost, and ensure a bright future for health care in Canada.

Thank you Commissioner Romanow and members of the Commission for your attention. We would be pleased to answer any questions you may have.

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