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Policy Matters: How to Improve Canadians’ Access to Essential Medicines
Peer countries have shown that faster access to new medicines is possible, which means there’s no reason to settle for the status quo in Canada.
Challenges in accessing timely medical care in Canada are well known — Canadians wait hours in emergency rooms or to undergo routine medical procedures. It’s no wonder then that almost 3 in 10 Canadians rank healthcare as a top 3 concern.
In Budget 2025, the federal government committed $5 billion to healthcare infrastructure. This money can be used to build new hospitals, invest in equipment, and train more doctors. It’s a welcome development, but more is needed to restore confidence in our medical system. In a wealthy country like ours, Canadians rightly expect timely access to quality healthcare.
The problem
An often-overlooked area for improvement is the time it takes for patients on public drug plans to get access to the latest medical innovations.
Out of G7 nations, Canadian patients on public plans have the longest average wait time for new drugs. And it’s even worse when compared to the averages of OECD countries — Germany provides access to new drugs in less than a year (11 months), while Canadians wait four years and four months!
Astronomical wait times mean that Canadians are forced to settle for inferior medicines, resulting in prolonged illness, inferior quality of life, and worse outcomes. All of this adds to the burden on our medical systems.
Why does it take so long to access new medicines in Canada?
A new drug goes through five steps before being listed on public plans. Each step adds its own delays, standing between patients and the best treatment for their illness.
Step 1: Any new drug, whether for public or private reimbursement, must be submitted to Health Canada for an initial regulatory review to evaluate its clinical efficacy and safety. This takes about a year on average though “priority drugs” (drugs that treat serious illness and/or respond to an unmet need) are generally fast-tracked to six months. Once this step is complete, a drug can be listed on private plans but not on public plans.
Step 2: Canada’s Drug Agency (CDA), an independent organization jointly funded by the federal and provincial governments (except for Québec, which uses the Institut national d’excellence en santé et en services sociaux (INESSS)), conducts a health technology assessment (HTA) to evaluate a drug’s cost-effectiveness and comparative efficacy. Then they advise provincial governments on whether to include the drug in their provincial plans and at what price. HTAs should be completed within 180 days but only a minority are. Plus, concerns have been raised about the CDA second-guessing Health Canada decisions, adding to the delays.
Step 3: The pan-Canadian Pharmaceutical Alliance (pCPA), which negotiates drug prices for provincial plans using their collective bargaining power to obtain lower prices, conducts a second review. Following a successful HTA, the pCPA has 40 days to decide whether to begin price negotiations. However, in 2024, only 20% of cases actually met this target.
Step 4: The actual pricing negotiations begin with a 60-day completion target set by the pCPA. This step has seen improvement — in 2019, less than 40% of cases met the target; however, in 2024, it was achieved in well over 90% of cases.
Step 5: Here is the most significant source of delay in a new drug’s reimbursement journey. Once pricing negotiations are concluded, it’s expected that the drug will be included in public plans — except there is no specified timeline for governments to do so, and average times vary significantly across provinces, from only 44 days in Quebec to 662 days in Prince Edward Island. The national average is approximately six months.
Governments lack incentive to list new drugs for a variety of reasons, including pressures to minimize public spending. Funny enough, offering newer treatments can drive savings in other segments of the healthcare system through shorter hospital stays, fewer emergency visits, and fewer specialist consultations — but these are not captured in current accounting methods.
The result of this cumbersome five-step process is that it takes more than two years — following Health Canada approval — for a drug launched in Canada to become available to patients on public plans. If patients in other countries are not subjected to such delays, we should not tolerate them in Canada.
What should the government do?
Ahead of the Council of the Federation’s summer meeting, we sent Premier and Council Chair Doug Ford a letter containing five recommendations that would make Canada’s access to new medicines timelines competitive with peer countries:
- Collaborate with provincial and territorial governments on a model that allows for the automatic listing of new drugs on public formularies following a positive CDA recommendation (or INESSS). The difference between the list price and the pCPA negotiated price should be reconciled retroactively following the conclusion of net pricing negotiations.
- Provide Health Canada with the resources it needs to meet its timelines for the review of new drugs, while keeping pace with evolving technologies, and implement the use of more efficient regulatory approaches such as rolling submissions.
- Explore additional opportunities for regulatory cooperation with peer jurisdictions and strengthen the effectiveness and industry uptake of international regulatory work-sharing models, such as the Access Consortium and Project Orbis, by enhancing transparency, aligning incentives, and building trust through greater predictability and clearer value for sponsors.
- Build on existing pathways so that new drugs can be reviewed simultaneously by Health Canada and Canada’s Drug Agency (or INESSS in Quebec) and incentivize greater uptake by industry.
- Establish a coordinated framework and transparent reporting mechanism to track the full reimbursement journey for new medicines in Canada, including public reporting on timelines from Health Canada approval through HTA review, pCPA negotiations and provincial formulary listings.
Following the Council’s meeting, improving access to medicines was recognized in the communiqué as a priority for provincial leaders.
We can’t wait any longer…
Accelerating access to the best treatments for the millions of Canadian on public drug plans would substantially reduce the burden on our medical systems by reducing emergency room visits and hospital stays. This would free up medical resources for everyone, in addition to potentially reducing total health care spending.
And then there’s the fact that improving access timelines will show that Canada is serious about supporting medical innovation. Better patient access timelines could boost R&D investment in the Canadian life sciences sector, creating well-paying jobs and supporting our economic resilience.
Peer countries have shown that faster access to new medicines is possible, which means there’s no reason to settle for the status quo in Canada. But most importantly, we owe it to the Canadians who struggle to access timely medical care and who are waiting for a new drug that will improve their quality of life or cure their illness.
To learn more about our advocacy on this topic, visit the Life Sciences Council.
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