Thanks to some new legislation,
Ontario doctors should soon have less paperwork, better
lines of communication with provincial health authorities
and easier access to cheaper drugs for patients.
All these changes are contained
in the Transparent Drug System for Patients Act (also
called Bill 102) which came into effect on October 1,
with several of its provisions set to kick in over the
next six months. The new regulations amend the Ontario
Drug Benefit (ODB) program — which provides prescription
drugs at no cost to elderly, disabled or welfare-recipient
patients — and the Drug Interchangeability and
Dispensing Fee Act.
A
GENERIC PROBLEM
Before Bill 102 was approved earlier this year, the
average prices of generic drugs were skyrocketing in
Ontario. In fact, the province has the highest average
generic drug costs in the developed world. With such
high costs to the province's Ministry of Health and
Long-Term Care, the sustainability of programs like
the ODB was in doubt — something had to be done.
THE
DRUGS THEY NEED
In June 2005, the Ministry of Health began a "system-wide
review" under the new Drug System Secretariat, led by
Helen Stevenson. That organization's recommendations
in January 2006 came to form the basis for Bill 102.
Physicians' concerns were considered carefully, said
Ms Stevenson, and the ministry decided to tackle two
major MD gripes: too much paperwork and too little transparency
in the decision-making process on approving exceptional
access to certain drugs (under a rule known as Section
8).
"The main problem physicians have
had recently with Section 8 is that you send in requests
for exceptional use and you don't get a response in
a timely fashion," said Dr Malcolm Moore, a Toronto
oncologist, "or you get a response that seems inconsistent
with principles used on previous reviews." Not only
was this a bunch of useless red tape for doctors, he
added, but it was a barrier to patient care.
Bill 102 regulates conditions for
exceptional access to drugs so doctors don't have to
apply again every time a similar situation arises. Dr
Moore, a former member and chair of the Ministry of
Health drug approval committee, said it also makes the
process of accepting new drugs to the formulary more
transparent.
All in all, Dr Moore thinks the
new regulations will make life easier for Ontario doctors
and their patients: "Bill 102 makes Section 8 much more
streamlined, he said."
CHEERS
AND JEERS
Some patient advocacy groups have cited concerns over
the creation of a powerful new office of the Executive
Officer, which has extensive powers over ODB drug approval.
Yet for the most part their reaction over Bill 102 has
been positive. Louise Binder of HIV-positive patient
advocacy group Canadian Action Treatment Council says
that the legislation's focus on getting more drugs to
more patients is a positive move.
Other aspects of Bill 102 have
proven more controversial. Pharmacists have been up
in arms over the government's strict limit on 'professional
allowance' rebates paid to pharmacies by generic drug
companies in exchange for using their products (a practice
which is entirely banned in the United States). Ontario's
high generic drug prices are partially due to this common
practice whereby pharmacists pay artificially high prices
for drugs and then get as much as 60% back in the form
of rebates.
Bill 102 attempts to provide some
compensation for disgruntled pharmacists: dispensing
fees will rise slightly, and pharmacists will begin
to receive payments soon for providing counselling services
for patients.
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