“System Broken: How Public Drug Coverage is Failing Canadians with Mental Illness” Report
An urgent call to the Government, provincial Health Ministers and Drug Plan Managers to remove administrative barriers to help Canadians
BELLEVILLE, ON, November 14, 2023 – A new report published today reveals substantial delays, a significantly higher rate of negative reimbursement recommendations for mental illness medications compared to medications for other medical disorders, and an inequality of publicly funded medications across Canada’s most populated provinces. Mood Disorders Society of Canada (MDSC) examined Canada’s public reimbursement review process for mental illness drugs approved by Health Canada between 2012 and 2022.
Each year, 1 in 5 Canadians are affected by mental illnesses. In addition, a report led by researchers at the Centre for Addiction and Mental Health (CAMH), University of Toronto, and Queen’s University for the Mental Health Commission of Canada, found that up to 90% of Canadians with serious mental illness are unemployed. This means that the majority of people will rely on provincial government, publicly-funded medication unless they have some type of private drug plan coverage through an immediate family member or other caregiver.
“When mental illness strikes, all Canadians deserve to have swift and equal access to the medications they may need to recover their wellness,” says Ken Porter, National Program Manager, MDSC. “We need to work with our government decision makers, health ministers, and all stakeholders to reduce the long administrative delays and roadblocks to medication access for people living with all types of mental illnesses today.”
Report3 highlights:
- More than 50% negative: more than half of the reimbursement recommendations for new medications for mental illness made by Canada’s assessment bodies were negative (Quebec: 62%, Rest of Canada: 54%), compared to only 17% negative recommendations for new medications for other non-oncology disorders during the same 10-year period.
- Time delays: the average time from Health Canada approval to public reimbursement was 949 days or just over 2.5 years after the medication was approved for Canadians.
- Provincial disparity: the vast majority of new medications assessed for this report are not equitably accessible through public drug plans across the country or are not accessible at all.
“If medication is a part of someone’s recovery journey, they need to be able to access any and all medications that work for them,” explains Dr. Diane McIntosh, Community Psychiatrist, and Clinical Assistant Professor at The University of British Columbia. “Yet, there are significant barriers impeding access to new medications through public drug plans, leaving the lives of many Canadians with mental illness at risk.”
A Call for Change
MDSC believes the report is a wake-up call for all stakeholders within the mental healthcare reimbursement system, including government officials, bureaucrats and other decision makers, to remove the barriers and prioritize viable solutions that can be effectively implemented to provide equitable public access to all medications for mental illnesses.
“Psychiatrists are clinical experts on the pharmacological management of psychiatric disorders,” says Dr. Pierre Blier, MD, PhD; Professor, Department of Psychiatry and Cellular/Molecular Medicines, University of Ottawa. “Unfortunately for patients, reimbursement decision makers don’t fully understand how prescribed medications work in real-world settings and how the newer medications provide critical benefits. We need to work together to offer more effective and accessible solutions to Canadians.”
Report: System Broken: How Public Drug Coverage is Failing Canadians with Mental Illness
MDSC engaged EVERSANA, a leading provider of global commercial services to the life sciences industry, to prepare this report. The analysis includes only original brand-name medications approved by Health Canada that underwent an initial or subsequent Health Technology Assessment (HTA) between 2012 and 2022 in Canada by the Canadian Agency for Drugs and Technologies in Health (CADTH) and/or the Institut national d’excellence en santé et en services sociaux (INESSS). The medications were approved to treat one or more of the following mental illnesses: anxiety disorders, including general anxiety disorder, panic disorder, and social anxiety disorder (social phobias); bipolar disorder; depression, including major depressive disorder and treatment-resistant-depression; insomnia; and schizophrenia.
The analysis evaluated reimbursement status and timelines for patient access to medications for mental illness that met the above parameters in four Canadian jurisdictions: British Columbia, Alberta, Ontario, and Quebec, as these four provinces account for more than 85 percent of the country’s population.
To access the full report, please visit accesstomedication.mdsc.ca.
Health Technology Assessment (HTA) and pCPA Process
The assessment of a medication’s clinical and cost-effectiveness for public coverage is conducted by the CADTH in all jurisdictions except for Quebec, where it is conducted by INESSS. A positive HTA recommendation is generally required to proceed in the provincial reimbursement process where the public drug plans collaborate through the pan-Canadian Pharmaceutical Alliance (pCPA), to negotiate pricing and reimbursement criteria with the drug’s manufacturer. A negative CADTH and /or INESSS recommendation greatly reduces the probability that a drug will be publicly reimbursed.
1 Smetanin P, et al.; RiskAnalytica, on behalf of the Mental Health Commission of Canada. The Life and Economic Impact of Major Mental Illnesses in Canada: 2011 to 2041External link. 2011
2 https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/2016-06/Workplace_MHCC_Aspiring_Workforce_Report_ENG_0.pdf
3 accesstomedication.mdsc.ca
About Mood Disorders Society of Canada
MDSC is a national, not-for-profit, voluntary health charity committed to ensuring that the voices of persons impacted by mental illness, family members and caregivers are heard on issues relating to mental health and mental illness, and in particular with regards to depression, bipolar illness, and other associated mood disorders. MDSC has evolved to become one of Canada’s best-connected mental health non-government organizations NGOs with a demonstrated track record for forging and maintaining meaningful and sustained partnerships with the public, private, and non-profit sectors throughout Canada.
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