Letter to the Chair of the Council of the Federation Regarding Faster Access to Life-Saving Treatments

The Honourable Doug Ford
Premier of Ontario and Chair of the Council of the Federation
99 Wellesley St. W.
Toronto ON M7A 1A1

Via electronic mail: premier@ontario.ca

Re: Faster access to life-saving treatments

Dear Premier Ford,

In your capacity as Chair of the Council of the Federation, the Canadian Chamber of Commerce and the undersigned provincial and territorial chambers of commerce are writing to encourage progress on speeding access to new medications for Canadians on public drug plans, an issue we were pleased to see highlighted in the communiqué following the Council’s December 2024 meeting.

In the time since the Council’s last meeting, a more uncertain economic and geopolitical environment has increased our collective attention on measures to strengthen the resilience of Canada’s economy: from advancing nation-building infrastructure projects to removing interprovincial barriers to trade and committing to record investments in our defence capabilities. There has rarely been such a window of opportunity to make progress on longstanding barriers to our collective prosperity. With Prime Minister Mark Carney also including faster access to new drugs in his electoral platform, we should make this a key pillar in our plans for a stronger Canada.

For far too long, Canada has lagged its peers in the time it takes for new medications to be available to patients on public drug plans. Following a drug’s first global launch, Canadians on public plans wait 52 months, on average, for access. Not only is this, by far, the worst in the G7, but it is also substantially above the OECD average of 45 months. The unnecessarily long wait times facing many Canadians to access innovative treatments means worse health outcomes, higher spending in other segments of our health care systems, and less investment in our life sciences industry.

Delays are caused by an overly complex approval and reimbursement process for new drugs, spread over several sequential steps. While there are delays at each stage of the approval process, the most important delays follow successful health technology assessments by Canada’s Drug Agency (INESSS in Quebec). At this stage, a drug has already been deemed to be safe, effective and socially beneficial, but before it is made available to patients on public plans, it must complete pan-Canadian Pharmaceutical Alliance (pCPA) pricing negotiations, which takes over one year on average. Governments must then actually include the drug on public formularies, which can take anywhere from an average of six weeks to almost two years, depending on the jurisdiction. Such timelines, as peer countries show, are needlessly long and prejudicial to patients on public plans.

With a renewed willingness and desire for collaboration between the provinces, territories and the federal government in the face of external threats, we believe that now is the time to tackle this issue head-on. Following extensive consultation with member life sciences companies and provincial chambers of commerce across the country, we submit the following recommendations for coordinated action by provinces, territories and the federal government:

• Collaborate on reimbursement models that allows for the automatic listing of new drugs on public formularies following a positive CDA (INESSS) recommendation. The difference between the list price and the pCPA negotiated price should be reconciled retroactively following the conclusion of net pricing negotiations.
• Build on existing pathways for new drugs to be reviewed simultaneously by Health Canada and CDA/INESSS and incentivize greater industry uptake.
• 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 more efficient regulatory processes 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.
• Establish a coordinated framework and transparent reporting mechanisms 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.

Implementing these recommendations will substantially reduce the time patients on public drug plans wait to access the latest medical innovations. With the pressures facing our health care systems and economy, we cannot settle for incremental progress. When patients in other G7 countries wait as little as a few months to access new drugs, it is unacceptable that we continue to expect Canadians to wait years for the same level of access. We also cannot continue to lose investment in our life sciences industry to other jurisdictions due to a lack of predictable and efficient regulatory pathways. Our ambition must not only be to make access to new drugs faster, but to establish Canada as a global leader.

We look forward to collaborating with provinces, territories and the federal government to deliver faster access to life-saving treatments and hope to see this issue again addressed at the upcoming Council of the Federation meeting on July 21-23. We are at your disposal to answer any questions relating to our recommendations or to discuss them in further detail.

Sincerely,

Candace Laing
President and CEO, Canadian Chamber of Commerce

Daniel Tisch
President and CEO, Ontario Chamber of Commerce

Véronique Proulx
President and CEO, Fédération des chambres de commerce du Québec

Chuck Davidson
President and CEO, Manitoba Chambers of Commerce

Newton Grey
President and CEO, Northwest Territories Chamber of Commerce

Prabha Ramaswamy
President and CEO, Saskatchewan Chamber of Commerce

Shauna Feth
President and CEO, Alberta Chambers of Commerce