Sales of medications to treat cancer have nearly tripled in Canada over the past decade, reaching $3.9 billion last year, a report by a federal agency says.
The Patented Medicine Prices Review Board has released data showing cancer medications account for about 15 per cent of all spending on pharmaceuticals.
“In 2019, medicines with 28-day treatment costs exceeding $7,500 made up 43 per cent of private plan oncology drug costs, compared with 17 per cent in 2010,” says the report by the board, which aims to protect consumers by ensuring manufacturers aren’t charging excessive prices for patented medications.
It says growth in the Canadian oncology market last year exceeded that of other countries including the United States and Switzerland, with a 20 per cent increase over sales from 2018.
Sales of oral cancer medications account for half of all oncology sales in Canada, up from 37 per cent in 2010, the report says, adding that while intravenous chemotherapy is publicly funded in all provinces, reimbursement of oral drugs differs across the country.
Steve Morgan, a professor in the School of Population and Public Health at the University of British Columbia, said it doesn’t make sense to cover the cost of intravenous chemotherapy in hospitals and not medications prescribed to patients outside of those facilities, but that’s justified in a country without a national drug plan.
“This is one of the messy bits of the Canadian health care system,” he said, adding there’s a patchwork system of coverage across jurisdictions, with cancer agencies in some provinces providing limited payment for at-home oncology treatments.
Clouded pricing
A national pharmacare plan would allow Canada to negotiate better drug prices, Morgan said, noting it’s the only country in the world with a universal health care system without coverage for prescription drugs.
Much of the national-level negotiating countries do with manufacturers happens in secret, Morgan said. The negotiations start with a list or sticker price — much like buying a vehicle at a dealership — as part of a complicated regime involving rebates to bring down prices.
“It’s deliberately made to cloud the real transaction price, the real price to health the system, so that no country can look at it and say, ‘Hey, wait a second, I heard that the people in Australia got this amazing new price on this drug,'” Morgan said.
A pharmacist serves a customer from behind protective screens in Nice, France, in May. Canada’s list prices for prescription drugs are among the highest in the world. (Valery Hache/AFP via Getty Images)
“What we can’t know is exactly which countries are getting the most value for money because we don’t get to see their secret deals. We do know that Canada’s list prices are among the highest in the world, and even above the level that the (Patented Medicine Prices Review Board) would like to see in terms of just the beginning of negotiations.
Countries with universal single-payer systems for medications — including Norway, Sweden, the United Kingdom, Australia and New Zealand — are likely using their negotiating power to get better prices from manufacturers asking for unreasonable amounts of money, he said.
Canada is expected to have about 225,000 new cancer cases and 83,000 deaths from the disease this year alone, the report by the Patented Medicine Prices Review Board says.
Provinces negotiate with manufacturers individually and should not “cave” to requests for unreasonable prices, Morgan said.
“They cannot, in essence, have patients being used as hostages.”
Prescription drug affordability
Results of an online survey released Thursday by the Angus Reid Institute (ARI) say 26 per cent of Canadians had to pay for at least half their prescription drug costs over the past year. That figure rises to 37 per cent for households earning less than $50,000 annually.
“Regionally, the highest rates of self-payment for prescriptions are found in British Columbia, Saskatchewan, and Manitoba,” said the survey. “In all three of these provinces, one in three households reported paying half of their prescription drug costs or more. By contrast, Ontario and Alberta report the highest rates of insurance and government coverage.”
The survey was conducted in partnership with the University of B.C.’s School of Population and Public Health, St. Michael’s Hospital in Toronto, the University of Toronto, Carleton University’s Faculty of Public Affairs and School of Public Policy and Administration in Ottawa and Women’s College Hospital, Toronto.
It was done between Oct. 13 and 18 included a representative randomized sample of 1,936 Canadians who are members of the Angus Reid Forum. For comparison purposes only, a probability sample of this size would carry a margin of error of +/- 2.2 percentage points, 19 times out of 20.
The survey was self-commissioned and paid for by ARI.
Demands for government intervention in Air Canada labour talks could negatively affect airline competition in Canada, the CEO of travel company Transat AT Inc. said.
“The extension of such an extraordinary intervention to Air Canada would be an undeniable competitive advantage to the detriment of other Canadian airlines,” Annick Guérard told analysts on an earnings conference call on Thursday.
“The time and urgency is now. It is time to restore healthy competition in Canada,” she added.
Air Canada has asked the federal government to be ready to intervene and request arbitration as early as this weekend to avoid disruptions.
Comments on the potential Air Canada pilot strike or lock out came as Transat reported third-quarter financial results.
Guérard recalled Transat’s labour negotiations with its flight attendants earlier this year, which the company said it handled without asking for government intervention.
The airline’s 2,100 flight attendants voted 99 per cent in favour of a strike mandate and twice rejected tentative deals before approving a new collective agreement in late February.
As the collective agreement for Air Transat pilots ends in June next year, Guérard anticipates similar pressure to increase overall wages as seen in Air Canada’s negotiations, but reckons it will come out “as a win, win, win deal.”
“The pilots are preparing on their side, we are preparing on our side and we’re confident that we’re going to come up with a reasonable deal,” she told analysts when asked about the upcoming negotiations.
The parent company of Air Transat reported it lost $39.9 million or $1.03 per diluted share in its quarter ended July 31. The result compared with a profit of $57.3 million or $1.49 per diluted share a year earlier.
Revenue totalled $736.2 million, down from $746.3 million in the same quarter last year.
On an adjusted basis, Transat says it lost $1.10 per share in its latest quarter compared with an adjusted profit of $1.10 per share a year earlier.
It attributed reduced revenues to lower airline unit revenues, competition, industry-wide overcapacity and economic uncertainty.
Air Transat is also among the airlines facing challenges related to the recall of Pratt & Whitney turbofan jet engines for inspection and repair.
The recall has so far grounded six aircraft, Guérard said on the call.
“We have agreed to financial compensation for grounded aircraft during the 2023-2024 period,” she said. “Alongside this financial compensation, Pratt & Whitney will provide us with two additional spare engines, which we intend to monetize through a sell and lease back transaction.”
Looking ahead, the CEO said she expects consumer demand to remain somewhat uncertain amid high interest rates.
“We are currently seeing ongoing pricing pressure extending into the winter season,” she added. Air Transat is not planning on adding additional aircraft next year but anticipates stability.
“(2025) for us will be much more stable than 2024 in terms of fleet movements and operation, and this will definitely have a positive effect on cost and customer satisfaction as well,” the CEO told analysts.
“We are more and more moving away from all the disruption that we had to go through early in 2024,” she added.
This report by The Canadian Press was first published Sept. 12, 2024.
