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  3. > IMS Pharmaceutical Pricing & Reimbursement Concise Guide: Canada

The Pharmaceutical Pricing & Reimbursement Concise Guides are established as the definitive reference and training text for P&R professionals around the world, drawing on the long-standing expertise of the IMS pricing and reimbursement specialists to provide industry players and decision makers with a thorough understanding of the rules and regulations governing P&R in international markets. This report covers key developments in P&R, market access, cost containment, trade margins and healthcare issues.

Table Of Contents

IMS Pharmaceutical Pricing and Reimbursement Concise Guide: Canada
CANADA 1
HEALTHCARE SYSTEM 1
Facts and Figures 1
Market Indicators 2
Provision and Funding 4
Public Sector 5
Private Sector 5
Background 5
PRICING 6
Prescription Drugs 6
New Patented Drugs 6
Existing Patented Drugs 11
Excessive Prices 12
DIP Methodology 13
Generic Drugs 14
Provincial Price Caps 14
Pan-Canadian Pharmaceutical Alliance 16
Professional Allowances 18
PMPRB Jurisdiction 18
Hospital Drugs 19
OTC Drugs 19
REIMBURSEMENT 19
Admission to Reimbursement 19
Overview 19
Public Drug Plans 20
Private Drug Plans 26
Reimbursement Categories 26
Public Drug Plans 26
Private Drug Plans 26
Reimbursement Prices 27
Public Drug Plans 27
Private Drug Plans 29
Hospital Reimbursement 29
Formularies 29
Funding 30
Out-patient Drugs 30
Changes in Reimbursement Status 30
Public Drug Plans 30
Private Drug Plans 31
Changes in Reimbursement Prices 31
Public Drug Plans 31
Private Drug Plans 32
PHARMACOECONOMICS 32
Pharmacoeconomic Requirements 32
Canada, Pharmaceutical Pricing and Reimbursement Concise Guide
v
Overview 32
Common Drug Review 33
Pan-Canadian Oncology Drug Review 39
Aligned Procedures 42
Quebec 46
Other Provinces and Territories 48
Price Build Up 49
Wholesalers 49
Margins 49
Background 50
Retail Pharmacies 50
Margins 50
Provinces 51
Dispensing Fees 52
Professional Allowances 53
Background 53
Dispensing Doctors 54
Sales Tax 54
COST CONTAINMENT 54
Industry Paybacks 54
Promotional Costs 54
Patient Co-payments 55
Public Drug Plans 55
Private Drug Plans 56
Uninsured 57
Prescribing Controls 57
Public Drug Plans 57
Private Drug Plans 58
Generics 58
Generic Substitution 59
Therapeutic Substitution 59
Generic Price Cuts 60
Private Label Generics 60
Biosimilars 60
Proposed IP Changes 61
Rx-to-OTC Switches 62
Parallel Trade 62
FUTURE DEVELOPMENTS 63
Outlook 63
Healthcare Funding Reform 63
PMPRB Reform 63
INESSS Reform 65
NAMES and ADDRESSES 66

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