• BC PharmaCare Newsletter Edition 10-003 has been released. Highlights include Prosthetic and Orthotic Program – Exchange Rate Update.

• BC PharmaCare Newsletter Edition 10-002 has been released. Highlights include H1N1 Vaccines for Visitors.

• BC PharmaCare Newsletter Edition 10-001 has been released. Highlights include Proton Pump Inhibitors – Expanded Coverage.

• BC PharmaCare Newsletter Edition 09-019 has been released. Highlights include an Interim Agreement Update between BC Pharmacy Association and the government of BC.

• BC PharmaCare Newsletter Edition 09-016 has been released. Highlights include New Limited Coverage Benefits and Criteria Changes.

• BC PharmaCare Newsletter Edition 09-017 has been released. Highlights include Olanzapine – Specific Products no Longer Eligible for PharmaCare Coverage.

• BC PharmaCare Newsletter Edition 09-018 has been released. Highlights include Flu Clinic Locator Website.

• BC PharmaCare Newsletter Edition 09-014 has been released. Highlights include Prosthetic & Orthotic Program – Breast Prostheses and Supplies Policy Clarification.

• BC PharmaCare Newsletter Edition 09-015 has been released. Highlights include H1N1 Flu Virus Information - Update #1 Antivirals & Vaccinations.

• BC PharmaCare Newsletter Edition 09-011 has been released. Highlights include Exchange Rate for the Prosthetic and Orthotic Program.

• BC PharmaCare Newsletter Edition 09-012 has also been released. Highlights include H1N1 Flu Virus – Antiviral Treatment & Distribution Plans.

• BC PharmaCare Newsletter Edition 09-013 has also been released. Highlights include Lost Cost Alternative (LCA) / Reference Drug Program (RDP) Booklet Changes.

• BC PharmaCare Newsletter Edition 09-009 which highlights Frequency of Dispensing-Pharmanet Solution Details has been released.

• BC PharmaCare Newsletter Edition 09-008 which highlights PharmaNet Changes for Frequency of Dispensing – Progress Report has been released.

• BC Pharmacare Newsletter Edition 09-007 which highlights coverage of ziprasidone (Zeldox®) has been released. Edition 09-006 of the Newsletter had also been released which highlights Implementation of the Frequency of Dispensing Transition Strategy
 

• Saskatchewan has released Formulary Committee Bulletin #121 effective December, 2009.

• Saskatchewan has released Formulary Committee Bulletin #120 effective October, 2009.

• Saskatchewan has released Formulary Committee Bulletin # 119 effective July 1, 2009.

• 1.7.1 Members – Dr. J. Tuchek is no longer on the DQAC. Dr. D. Seibel is no longer on the SFC.

• 1.8 Organizational Chart – Dan Florizone is the new Deputy Minister of Health.
 

• Ontario has released Update P to the ODB Formulary, effective March 2, 2010.

• Ontario has released Update O to the ODB Formulary, effective January 5, 2010.

• Ontario has released Update N and Update N1 to the ODB Formulary, effective November 19, 2009.

• Ontario has released Update M to the ODB Formulary, effective November 13, 2009.

• Ontario has released Update L to the ODB Formulary, effective September 30, 2009.

• Ontario has release Update J to the ODB Formulary, effective June 23, 2009.

• Ontario has release Update I to the ODB Formulary, effective May 20, 2009

●  The Ontario Ministry of Health and Long-Term has released a Notice from the Executive Officer, dated February 23, 2009, announcing that, effective immediately, the following additions/enhancements will be made to the drug submission status postings:

• Diabetic test strips will be added to the single-source submission postings
  Each single-source submission status report will include the date on which the submission has been deemed complete

• A monthly report of all complete streamlined Off-Formulary Interchangeability (OFI) submissions will be added to the multiple-source submission postings

• Drug submission status postings can be found at the Ontario Public Drug Programs website.

●  The Ontario Ministry of Health and Long-Term Care has released Update G to the Ontario Drug Benefit Formulary/Comparative Drug Index Edition Number 41, effective March 2, 2009. Highlights of the changes include:

• 6 new single source drug products

• 7 new multiple source drug products - all are at or below the 50% generic price rule

• 3 multiple source drug products listed as interchangeable under the Off-Formulary Interchangeability (OFI) drug listing

• 40 adjusted Drug Benefit Prices (DBP) on existing drug products

• 12 routine housekeeping changes, including reinstatement to active status of R & C Shampoo, Nix Dermal Cream and Kwellada-P

Also, the following products have been approved for reimbursement under the Ontario Public Drug Programs' Exceptional Access Program (EAP). EAP requests will be processed when the ministry implements the recommendation(s):

• Celsentri - For the treatment of HIV-1 infection in patients with CCR5 tropic virus and evidence of virologic failure despite optimal antiretroviral therapy and documented genotypic (or phenotypic) resistance to at least one of each: NRTI, NNRTI, and PI.

• Revlimid - For the treatment of anemia due to myelodysplastic syndrome with a deletion 5q cytogenetic abnormality.

• Eprex - For the treatment of palliative cancer patients, anemia secondary to MDS, anemia secondary to chronic renal failure, anemia secondary to hepatitis C therapies, and pre-operative use.

• The Ministry of Health and Long-Term Care has released a Notice from the Executive Officer , reminding pharmacies and drug manufacturers that Professional Allowance Reports for the period of July 1, 2008 to December 31, 2008 must be submitted no later than February 28, 2009. All reports must be submitted using the excel templates provided on the Ministry’s website.

The Ontario Ministry of Health and Long-Term Care has released Update F to the Ontario Drug Benefit Formulary/Comparative Drug Index Edition Number 41, effective January 30, 2009. Highlights of the changes include:

• 6 new single source drug products.

• 11 new multiple source drug products – 10 are at or below the 50% generic price rule.

• 4 multiple source drug products listed as interchangeable under the Off-Formulary Interchangeability (OFI) drug listing

• 136 adjusted Drug Benefit Prices (DBP) on existing drug products

• 19 routine housekeeping changes

• New Brunswick has released Update 4 to Volume 51 of the New Brunswick Formulary.

• New Brunswick has released Update 3 to Volume 51 of the New Brunswick Formulary.

• New Brunswick has released Update 2 to Volume 51 of the New Brunswick Formulary.

Voluntary Compliance Undertaking ("VCU")

On January 26, 2010, the Chairman of the Board approved a VCU from Bayer Inc. in relation to the medicine Xarelto (rivaroxaban), which is indicated for the prevention of venous thromboembolic events in patients who have undergone elective hip or total knee replacement surgery. According to the VCU, Xarelto’s price exceeded the PMPRB’s international price guideline at introduction and in 2009. Bayer has undertaken to offset cumulative excess revenues accrued from September 18, 2008 to June 30, 2009 by making a payment to the Crown in the amount of $49,978.33. Bayer also undertakes to make further payment to Her Majesty for any additional excess revenues received after June 30, 2009.

January 2010 NEWSletter Released

The January 2010 edition of the quarterly PMPRB NEWSletter has been released. Included in this edition are:

• 2009 CPI adjustment factors: The PMPRB has published the actual CPI adjustment factors that will be used in its calculation of the 2009 MNEs. While the PMPRB had used a 2.0% inflation forecast in its determination of forecast CPI adjustment factors for 2009, the actual change in CPI for 2009 over 2008 was only 0.3%. As a result, the actual CPI adjustment factors for 2009 are significantly lower than the forecast (e.g., 3-yr adjustment of 1.049 vs 1.065, respectively) and the actual one-year increase cap has come in at 0.5% as opposed to the 3.0% previously forecast.
   
• Changes / additions to the PMPRB’s personnel and additions to the Human Drug Advisory Panel membership, the latter of which is to accommodate increased workload of the HDAP as a result of the new Guidelines. The "Comings and Goings"’ and "Human Drug Advisory Panel" sections of the January 2010 PMPRB NEWSletter presents an overview of those changes.
   
• Other PMPRB NEWSletter topics covered include:
  • Completed and Ongoing Hearings
  • New Patented Medicines Reported to PMPRB (period October to December 1, 2009)
  • Voluntary Compliance Undertakings (''VCUs'')
  • Sprycel – 2009 New Medicine Review (Category 2)
  • Board Meeting Activities
  • Upcoming Events

Voluntary Compliance Undertakings (VCUs)

On February 1, 2010, the PMPRB announced the Chairman’s acceptance of the following two VCUs:

• A VCU from Schering-Plough Canada Inc. in relation to the medicine Claritin Allergy and Sinus Extra Strength (10 mg loratadine / 240 mg pseudoephedrine sulphate), which is indicated for the relief of symptoms associated with allergic rhinitis. According to the VCU, the introductory price of Claritin Allergy & Sinus ES in Canada was above the maximum non-excessive price established by the PMPRB; the product was classified as a category 1 new medicine. Schering-Plough undertakes to offset the cumulative excess revenues received during the period January 1, 2005 through June 30, 2009 by making a payment to Her Majesty in the amount of $69,950.43. Schering-Plough also undertakes to ensure that the price of Claritin Allergy & Sinus ES remains within the Guidelines in all future periods during which the product is under the PMPRB’s jurisdiction.
   
• A VCU from Fresenius Kabi Canada in relation to the medicine Voluven (hydroxyethyl starch), a product indicated for the treatment of hypovolemia. The Human Drug Advisory Panel recommended that Voluven be classified as a Category 1 new medicine and identified Hextend and Pentaspan as the most appropriate comparable medicines. However, the PMPRB staff concluded that the Reasonable Relationship (RR) test methodology was not appropriate in this instance because of differences in molecular structure and pharmacokinetic/ pharmacodynamic properties versus other hetastarch preparations. Thus, a Therapeutic Class Comparison (TCC) and an International Price Comparison (IPC) test were conducted, resulting in the introductory price of Voluven appearing to exceed the Guidelines. Fresenius Kabi undertakes to offset cumulative excess revenues received during the period March 3, 2007 through August 7, 2008 (the patent expiry date) by making a payment to Her Majesty in the amount of $1,448,002.25.

Board’s Decision on Pentacel and Quadracel

The PMPRB Hearing Panel has published its Decision on the merits regarding the prices of Quadracel and Pentacel (sanofi pasteur Limited). The original Notice of Hearing was issued in March 2007. Quadracel and Pentacel have been sold in Canada since June 1997 and are combination or multi-component vaccines that protect against four and five different diseases, respectively. In the Board Staff’s Statement of Allegations, it is alleged that sanofi pasteur sold Quadracel (from 2002-2006) and Pentacel (2002-2007) at excessive prices. Sanofi pasteur argued that the Board Staff applied the Guidelines (and in particular the CPI Guidelines) incorrectly. In its decision, the Hearing Panel concluded that the prices of Quadracel and Pentacel were excessive and that patentees cannot “contract out” the CPI guideline (a reference to sanofi’s reliance on the CPI price increase provisions in the contracts with the Canadian government). The Panel directed sanofi pasteur to reduce the prices at which it sells the vaccines during the term of the current contract with the Government of Canada to levels that offset the excessive revenues (as yet to be calculated) that have accrued to date. The Panel also instructed the PMPRB staff and sanofi pasteur to determine the ATPs and MNEs of Quadracel and Pentacel as if discounts to Ontario had not occurred.

Please consult the PMPRB’s website for more details.

Federal Court Quashes PMPRB Copaxone Decision

• In a November 12 2009 decision, Justice Hughes of the Federal Court of Canada ruIed that the PMPRB’s finding of excessive pricing in the Teva Neuroscience / Copaxone matter was “unreasonable” and the calculation of excess revenues “unintelligible”.   The Judge concluded that the Board, in reaching its decision, had relied solely on the CPI guideline to the exclusion of the other excessive price factors listed in section 85 of the Patent Act (e.g., prices of other drugs in the therapeutic class, international prices.). The matter has been referred back to the Board for a new hearing (by a different hearing panel if possible).  The Attorney General of Canada has 30 days to appeal the decision.

  The implications of the decision may be far reaching.The PMPRB’s compliance and enforcement policies are built on price tests that reflect the excessive price factors in s. 85 but are premised on a presumption of excessive pricing if the price of a patented medicine contravenes just one of the price tests.  The Federal Court decision requires the Board to consider and give some weight to all of the factors.  Moreover, the tenor of the decision would suggest that this consideration should occur well in advance of the formal hearing process.  For example, Board Staff could be required to give some weight to all the s. 85 factors when conducting an investigation into the price of a patented medicine that failed any one particular price test.  How this would be accomplished remains to be seen.  However, with the 2010 implementation of the revised guidelines, this decision offers patentees yet more uncertainty to uncertain times.

  For more information, or a copy of the Federal Court decision, please contact Neil Palmer or Janice D’Angelo.

●   October 2009 NEWSletter Released

The October 2009 edition of the quarterly PMPRB NEWSletter has been released. This edition provides updates on some ongoing PMPRB activities, including:

• The new Excessive Price Guidelines which will come into force on January 1, 2010. The Board Staff will be monitoring and evaluating the application and impact of the changes to the Guidelines on an ongoing basis once in effect. On September 17, 2009, the Board met and discussed the monitoring and the evaluation of the Board’s new Excessive Price Guidelines. Dr. Benoit states in the October 2009 NEWSletter that ‘’the revised Guidelines will provide greater transparency and predictability in the price review process’’. Outreach sessions were held in late October, in Montreal and Toronto, on the upcoming application of the Guidelines.
• The Federal Court of Canada heard the Application for Judicial Review on the Board’s decision in the matter of Teva Neuroscience and the medicine Copaxone. The PMPRB issued a Board Order and Reasons on May 12, 2008 in relation to this matter. This was in accordance with the Decision of the Board issued on February 25, 2008, finding that the medicine was sold at an excessive price in 2004 and 2005. The Federal Court decision is pending.
• Other NEWSletter topics:
  • Completed and Ongoing Hearings
  • New Drugs Introduced since July 2009 NEWSletter
  • Pradax – 2008 New Medicine Review (Category 3)
  • Board Meeting Activities
  • Upcoming Events

Voluntary Compliance Undertakings (''VCUs'')

On October 21, 2009, the Board approved a VCU from Amgen in relation to the medicine Neulasta (pegfilgrastim), which is indicated to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anti-neoplastic drugs. For the purpose of resolving the matter relating to the Notice of Hearing issued in March 2009, Board Staff and Amgen agree that Neulasta is properly classified as a Category 3 new medicine and that the application of a domestic therapeutic class comparison pricing test with Amgen’s Neupogen (filgratim) as the comparator is appropriate. Amgen undertakes to make a payment to the Crown in the amount of $6,730,120.32 to offset any revenues above the maximum prices set out in the VCU.

On October 16, 2009, the Board accepted a VCU from Schering-Plough Canada Inc. regarding the price of Andriol (testosterone undecanoate), a medicine indicated for the replacement therapy in males for conditions associated with a deficiency or absence of endogenous testosterone. Schering-Plough will provide a discount of 21.25% against the 2009 MNE price to all customers through to end-December 2010 and will offset excess revenues deemed to have accrued over the period November 1 through December 31, 2004 by making a payment to Her Majesty in the amount of $348,605.86.

On October 5, 2009, the Board approved a VCU from Baxter Corporation in relation to the medicine Brevibloc (esmolol hydrochloride), a product indicated for the perioperative management of tachycardia and hypertension. In addition to a price reduction put in place by Baxter in June 2009, the company will offset cumulative excess revenues by making payments totaling $212,440.76 to customers that previously purchased Brevibloc.

●   The 2008 PMPRB Annual Report was tabled before Parliament on July 22, 2009 and subsequently published by the PMPRB. The report provides detailed information on sales and price trends of medicines in Canada, including:

• The R&D-to-sales ratio for all patentees decreased in 2008 to 8.1% from 8.3% recorded in 2007. The R&D-to-sales ratio for Rx&D member companies remained at 8.9%.
• Canadian prices of patented medicines during 2008 were 0.1% above 2007 levels. The CPI rose by 2.3% during the same period.
• Prices in only three [Germany, UK, US] of the seven PMPRB reference countries recorded overall price increases in 2008 over 2007. Canadian prices were approximately 4% above international median prices, on average, but lower than their highest international price. The full document can be accessed on PMPRB's website.

●   PMPRB Update - January 2009 NEWSletter Released

The January 2009 edition of the quarterly PMPRB NEWSletter has been released. This edition provides updates on some ongoing PMPRB activities, including:

●   Update on the Proposed Changes to the Excessive Price Guidelines.

The Board is finalizing its review of the feedback received in response to the August 20, 2008 package, which included extensive changes to PMPRB's Excessive Price Guidelines. The PMPRB is still considering some areas where stakeholders' comments were more significant. The PMPRB plans to release a new version of the draft revised Guidelines in March 2009, which will be the subject of a final Notice and Comment period, followed by release of the final text of the Guidelines around the end of May. Implementation of the new Guidelines is anticipated for July 1, 2009.

On November 25, 2008, the PMPRB issued a Communiqué  temporarily suspending patentees' mandatory reporting of benefits for the January 1 to June 30, 2009 reporting period. The judicial reviews on this matter, resulting from applications filed by Pfizer Canada and Rx&D et al., are scheduled for June 16-17. The PMPRB, anticipating that a Federal Court decision is not likely prior to July 1, 2009, has suspended mandatory reporting of benefits until January 1, 2010.

●   2008 CPI adjustment factors: The PMPRB has published the actual CPI adjustment factors that will be used in the calculation of 2008 MNEs. While the PMPRB had used a 2.0% inflation forecast in its determination of forecast CPI adjustment factors for 2008, the actual change in CPI for 2008 over 2007 was 2.4%. As a result, the actual CPI adjustment factors for 2008 are higher than forecast (e.g. 3-yr adjustment of 1.066 vs 1.057, respectively) as is the cap on one year increases in 2008 (3.6% vs 3.0%, respectively). These will result in higher than expected MNEs for 2008.

●   REMINDER: The deadline for filing PMPRB Form 3 - Revenues and Research and Development Expenditures is March 2, 2009.

●   Other NEWSletter topics:

- Completed and Ongoing Hearings
- New Drugs Introduced since October 2008 NEWSletter
- Revlimid - 2008 New Medicine Review (Category 2)
- Board Meeting Activities
- Upcoming Events

The Board has postponed the hearing in the matter of Eli Lilly Canada and its medicine Strattera to  February 11, 2009. The hearing was originally scheduled from January 27 to 29, 2009.

Board Communiqué on Mandatory Reporting

The PMPRB issued a Communiqué on November 25, 2008 temporarily suspending patentees' mandatory reporting of benefits for the January 1 to June 30, 2009 period as a result of Rx&D et al. and Pfizer Canada's applications for Judicial Review stemming from the Board's August 18, 2008 Communiqué.

The Board is continuing its assessments of the issues relating to its Draft Revised Excessive Price Guidelines and will be communicating next steps through its website and NEWSletters.

The October edition of the quarterly PMPRB NEWSletter has been released. This edition provides updates on several PMPRB activities, including:

     ●   Update on the Proposed Changes to the Excessive Price Guidelines

On August 20, 2008, the Board released a PMPRB Notice and Comment package which included extensive changes to PMPRB’s Excessive Price Guidelines. Interested parties were asked to provide comments on the proposed changes. The comments received since then have been posted on the PMPRB's website. The Board met on October 22 to review stakeholders’ comments and is continuing its assessment of the issues. Updates on its progress will be communicated on the PMPRB’s website and through its NEWSletters. According to the original August 18, 2008 PMPRB Communiqué, the amended Compendium of Policies, Guidelines and Procedures as well as transition and implementation plans are to be released on November 17, 2008.

     ●   Additional NEWSletter topics: 

- Completed and Ongoing Hearings
- 2009 HDAP Meeting Schedule
- Lucentis - 2007 New Medicine Review (Category 2)
- New Drugs Introduced since July 2008 NEWSletter
- Upcoming Events

PMPRB Updates

Apo-Salvent Hearing

The PMPRB has postponed the pre-hearing conference in the matter of Apotex and its medicine Apo-Salvent, originally scheduled on September 29, 2008. Apo-Salvent is a new DIN of an existing dosage form of an existing bronchodilator (salbutamol sulfate). The drug is indicated for the relief of chest tightness and wheezing caused by spasms or narrowing in the small air passages of the lungs. The Board will be announcing a new date shortly. Please consult the PMPRB's website for more information.

Proposed Changes to the Excessive Price Guidelines

REMINDER: Interested parties have until Monday, October 6, 2008, to submit their comments on the PMPRB’s Notice and Comment August 20, 2008 package, which includes extensive changes to the PMPRB’s Excessive Price Guidelines. Responses to the proposed changes should be sent to the Secretary of the Board by e-mail at sdupont@pmprb-cepmb.gc.ca  , or by mail at:

Sylvie Dupont
Secretary of the Board
Patented Medicine Prices Review Board
Box L40
Standard Life Centre
333 Laurier Avenue West
Suite 1400
Ottawa, Ontario
K1P 1C1

More information on the topic and comments received to date are provided on the Board's website.

HDAP Meeting Schedule

The PMPRB has released the Human Drug Advisory Panel (HDAP) meeting schedule for 2009:

- February 19, 2009

- May 15, 2009

- September 17, 2009

- November 19, 2009.

Details on submission deadlines are provided on the Board's website.