Access to Medicines
Access to medicines is a huge priority for everyone in the cystic fibrosis (CF) community.
Highly effective CFTR modulator therapies now exist, improving health outcomes and helping people with cystic fibrosis live longer, healthier lives.
Unfortunately, a lack of access to these medications means that very few people living with CF in Canada currently benefit from these advances.
Cystic Fibrosis Canada has been advocating for fast and fair access to modulators approved by Health Canada and to symptom management drugs where needed. We have had successes, but there are still far too many gaps in access to CF medications and disparities among provinces in how they are funded.
In the fall of 2019, the newest CFTR-modulating medication, Trikafta, was designated a breakthrough medication in the U.S. and fast-tracked for approval. CF Canada and the Canadian CF community sprang into action, working hard to overcome the barriers to access for Trikafta in Canada. Learn more about Trikafta.
Kalydeco (ivacaftor) is a pill for people ages 6 and older who have the G551D mutation of CF which helps the defective CFTR protein work at the surface of the cell.
Orkambi (lumacaftor/ivacaftor) is indicated for the treatment of cystic fibrosis (CF) in patients 2 years of age and older who are homozygous for the F508del mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.
Symdeko is a precision medicine that is used to treat cystic fibrosis in people who have a particular set of genetic mutations. A disease-modifying drug, it is a combination of ivacaftor and tezacaftor.
Trikafta (elexacaftor/ivacaftor/tezacaftor) has not been submitted for approval in Canada. CF Canada is pushing hard for Canadians to have access to this life-saving medication.
Our CEO, Chief Scientific Officer, program team, volunteers and Board are pushing for three things:
- To get Trikafta submitted, fast-tracked and approved by Health Canada.
- To get public funding for all modulator drugs that are currently approved in Canada.
- To have a regulatory and reimbursement environment in Canada that does not unnecessarily limit our access to new life-saving therapies.
Our work towards this includes:
- Increased pressure on the federal and provincial governments (including the PMPRB) to do the right thing, through media, meetings, letters, formal submissions, consultations and much more.
- Increased pressure on the drug manufacturer to work with the government, through meetings and ongoing discussions.
- Continued activation and management of our National Advocacy Network of more than 200 trained volunteers across the country, to support the above in all provinces.
- Increased resourcing towards these goals, including dedicated government relations consultants and communications professionals.
In May of 2017, Health Canada proposed changes to the Patented Medicines Prices Review Board (PMPRB) regulations. These changes incorporate new factors in determining whether a medicine is being or has been sold at an “excessive” price.
Since the changes to the Patented Medicines Regulations were first proposed, the patient community has consistently raised concerns that these changes will negatively impact access to new medicines for Canadian patients.
The new PMPRB regulations require patented drug manufacturers to significantly reduce their prices. By some estimates, these changes will require reductions in price as high as 75%, but the actual reductions depend on a number of assumptions that themselves are creating uncertainty. Upon implementation, Canada will become an outlier among OECD countries and a much less attractive market in which to launch innovative therapies, including precision medicines that can alter the course of devastating diseases like cystic fibrosis.
The impact these regulatory changes have had is chilling. From November 1, 2019 to February 29, 2020 Health Canada registration of new clinical trials decreased by 60% compared with the average of four years prior. Moreover, “between 2015 and 2018, 49 per cent of new drugs were approved in Canada either prior to or within a year of their approval in the United States. In 2019, the rate fell to just 15.6 per cent. That’s a drop of more than two-thirds.” - Nigel Rawson, & John Adams, Price controls imposed by shortsighted politicians keep new life-saving drugs out Financial Post. Retrieved from https://business.financialpost.com/opinion/price-controls-imposed-by-clueless-politicians-keep-new-life-saving-drugs-out
The PMPRB, and the federal government, have repeatedly assured patient groups that access to new medicines will not be impacted by the proposed regulatory changes. Unfortunately, we now know that access to new drugs for Canadians with cystic fibrosis has not only been delayed, but may be denied altogether.
Canada's drug review and reimbursement system is already onerous, duplicative, and inadequate. It can take between 2-5 years for some drugs to get to patients, and even longer for precision medicines and drugs for rare diseases, if these medicines get to patients at all. These regulatory changes will make it even more difficult to get life-changing and life-saving medicines to patients.