Multi Stakeholder Steering Committee – Brief Report Drug Shortages

1. Multi Stakeholder Steering Committee – Brief ReportDrug Shortages Best Medicines Coalition Denis Morrice Canadian Epilepsy Alliance June 12, 2018

2. Drug Shortages • A serious issue and getting worse • Drug shortages last about 4-5 months (Myochrisine) • For patients = stress and harm – delayed treatment and surgeries • For physicians and pharmacists = time consuming and often frustrating searches for alternatives • For governments = increase healthcare expenditures

3. Drug Shortages • Over 70% are generic • Over 20% are innovator • Approximately 1,000 shortages are reported annually • Physicians had to change patients from well-established and successful drug regimens to new and untested ones that were sometimes therapeutic failures

4. Drug Shortages • Interesting although Global issue: • Europe, North America and China: cancer, arthritis, cardiovascular, hormonal diseases, and epilepsy • Australia and New Zealand: antivirals, antibiotics and cardiac drugs • African nations: malaria, tuberculosis and HIV-AIDS

5. Results so far • Federal Cttees • Provincial cttees • Hospital Pharmacy Cttees • Drug Shortage website • Global Issue • Tool kits • MSSC • No real solutions – all symptom solving

6. Other Points • The precise causes of Canadian drug shortages are unknown • A reminder: 10 percent of Canadians cannot afford their prescription drugs – DD (2,600% price hike on an epilepsy drug). • The Drug Shortage website is operated by Bell Canada under contract with Health Canada, rather than by industry.

7. E.G. Antibiotic Drug Shortage • Fuelling the rise in antimicrobial resistance • Antibiotic supply chains are on the “brink of collapse • 15 countries, including the UK, reported national shortages of injectable streptomycin • Drug-resistant superbugs are rising in the UK • In Brazil, this shortage coincided with an outbreak of syphilis • Pharmaceutical industry has little incentive to take action – Cos leaving the market in droves

8. Other Points • C.D. Howe Report: Read it!! • Fast-tracking or accelerated review • Essential Medicines List EMLs • Information about alternatives and substitutes • Development of new manufacturing technologies • Learning more about unknown causes • Track and document manufacturing problems: • Study and control market forces and the appropriate price for generic drugs

9. Other Points C.D. Howe • Create a nationally owned pharmaceutical manufacturing entity • Encourage more competition between manufacturers, and expedite approvals • Encourage increased harmonization between the generic and innovator industries • Encourage greater transparency and patient engagement • Only when the causes are identified can solutions be found.

10. Multi-Stakeholder Steering Cttee • To address all aspects of Drug Shortages • F2F meeting June 26 • Points and comments you want me to make: Dmorrice@klick.com • The following are the Org reps to the MSSC

11. Multi-Stakeholder Steering Committee – Drug Shortages Government: Health Canada (3 reps) CADTH Provinces (3 reps): Manitoba, Saskatchewan Doctors: Canadian Medical Association Pharmacists: Canadian Society of Hospital Pharmacists Canadian Pharmacists Association Neighbourhood Pharmacy Association of Canada

12. Multi-Stakeholder Steering Committee – Drug Shortages Industry: Innovative Medicines Canada Canadian Generic Pharmaceutical Association BIOTECanada Distribution: HealthPRO Medbuy Canadian Association for Pharmacy Distribution Management

13. MSSC Drug Shortages Hospitals: HealthCareCAN Patients: Best Medicines Coalition Member reps: Presidents, VPs, CEOs, Deputy and ADMs, and Directors in their organizations