[Congressional Record (Bound Edition), Volume 146 (2000), Part 14]
[Extensions of Remarks]
[Page 20839]
[From the U.S. Government Publishing Office, www.gpo.gov]



                           PRESCRIPTION DRUGS

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                          HON. PHILIP M. CRANE

                              of illinois

                    in the house of representatives

                       Wednesday, October 4, 2000

  Mr. CRANE. Mr. Speaker, as the Congress continues to debate the 
question on how to provide seniors with affordable prescription drugs, 
I wanted to bring to my colleagues attention the article ``Prescription 
Drug Costs: Has Canada Found the Answer?'' by William McArthur, M.D. 
Dr. McArthur is a palliative care physician, writer and health policy 
analyst in Vancouver B.C. Some of our colleagues have been touting the 
affordability of prescription drugs in Canada and in some cases 
sponsoring bus trips for seniors across the border to obtain these 
drugs. We should be skeptical of this approach because, in reality, the 
Canadian government drug mandates harm patients and increase the costs 
in other sectors of the health care system.
  The Canadian bureaucracies cause significant delays in access to new 
and innovative drugs. First, at the federal level, Canadians wait up to 
a year longer than Americans do for approval of new drugs. Then the 
delays continue at the provincial level where various government 
``gatekeepers'' review the ``therapeutic value'' of prescription drugs 
before they are included in the formulary. The length of the delays 
varies widely. The government officials in Nova Scotia approve drugs 
for its formulary in 250 days, while the wait in Ontario is nearly 500 
days.
  Canadian patients are often forced to use the medicines selected by 
the government solely for cost reasons. Patients who would respond 
better to the second, third, or fourth drug developed for a specific 
condition are often denied the preferred drug, and are stuck with the 
government-approved ``one size fits all'' drug.
  I urge my Colleagues to read this article and keep in mind that while 
prescription drugs appear to cost less in Canada than in the United 
States, there is a costly price associated with the Canadian system 
that ultimately translates into a lack of quality care for patients.

       [From the National Journal's Congress Daily, Oct. 2, 2000]

         Prescription Drug Costs: Has Canada Found the Answer?

                      (By William McArthur, M.D.)

       Some Americans faced with the rising costs of prescription 
     drugs look longingly at Canada, where prescription drugs 
     appear to cost less than in the United States. The fact is 
     that, while some drugs do cost less in Canada, others don't. 
     Furthermore, many drugs are not available at any cost in 
     Canada. The effect of Canadian policies is to restrict the 
     overall availability of prescription drugs through a 
     combination of a lengthy drug approval process and oppressive 
     price controls.
       First of all, Canada's federal drug approval process takes 
     much longer than that of the U.S., resulting in delayed 
     access for Canadians to new drugs. For example, Canadian 
     acceptance of the drug Viagra came a whole year after it had 
     been available in the U.S. For 12 months Canadians who needed 
     Viagra, or another of the many drugs delayed or denied 
     approval, had to go to the U.S. to get their medication.
       Even if a drug wins federal approval, it faces 10 more 
     hurdles to become widely accessible--the 10 provinces. Each 
     province has a review committee that must approve the drug 
     for reimbursement under the public healthcare system. For 
     example, in British Columbia, neither the new anti-arthritic 
     drugs Celebrex and Vioxx, nor the Alzheimer's treatment 
     Aricept, have been approved for reimbursement, severely 
     limiting their availability. Further, the provincial approval 
     times vary greatly from province to province, creating 
     further inequities.
       Price controls imposed by a government agency, the Patented 
     Medicines Price Review Board (PMPRB), are the reason some 
     prescription drugs cost less in Canada than in the United 
     States. However, while keeping some prescription drug prices 
     down through price controls, Canada has been unable to 
     control overall drug spending. OECD statistics reveal that 
     when the PMPRB was created in 1988, per capita expenditure on 
     prescription drugs was $106; by 1996 that had doubled to $211 
     per person. One study of international drug price comparisons 
     by Prof. Patricia Danzon of the Wharton School of the 
     University of Pennsylvania concluded that, on the average, 
     drug prices in Canada were higher than those in the United 
     States. Some individual drugs, particularly generics, cost 
     far more in Canada. For example, the anti-hypertensive drug 
     atenolol is four times more expensive in Canada than in the 
     United States. And a University of Toronto study found that 
     the main effect of price controls on prescription drugs was 
     to limit patients' access to newer medicines so that they had 
     to rely more on hospitals and surgery.
       All provinces require that chemically identical and cheaper 
     generic drugs be substituted for more expensive brand-name 
     drugs when they are available. However, British Columbia has 
     gone farther with a ``reference price system.'' Under this 
     system, the government can require that a patient receiving a 
     drug subsidy be treated with whichever costs the least: (a) a 
     generic substitute, (b) a drug with similar but not identical 
     active ingredients or (c) a completely different compound 
     deemed to have the same therapeutic effect. Patients are 
     often forced to switch medicines, sometimes in mid-treatment, 
     when the reference price system mandates a change. Twenty-
     seven percent of physicians in British Columbia report that 
     they have had to admit patients to the emergency room or 
     hospital as a result of the mandated switching of medicines. 
     Sixty-eight percent report confusion or uncertainty by 
     cardiovascular or hypertension patients, and 60 percent have 
     seen patients' conditions worsen or their symptoms accelerate 
     due to mandated switching.
       Through limiting the availability of prescription drugs and 
     controlling the prices of those that are available, Canada 
     has succeeded only in preventing Canadians from obtaining 
     drugs that might have reduced hospital stays and expensive 
     medical procedures. The end result of this is that Canadians 
     are getting a lower standard of health care at a higher cost 
     than patients and taxpayers have a right to expect.
       One lesson that Americans should learn from the Canadian 
     experience is that when government pays for drugs, government 
     controls the supply. As soon as government has to pay the 
     bill, efforts are made to restrict the availability of newer 
     and more effective drugs. The inevitable result is that other 
     health expenditures like surgery and emergency visits 
     increase, and patients suffer.

     

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