By the Numbers: Outcomes-based Agreements
April 22, 2021
Specialty medications in Canada face various challenges on the road to timely and equitable access. Fortunately, innovative market access agreements are bridging the gaps.
Race to reimbursement
53%: Average proportion of approved Canadian drugs that receive public reimbursement in Canada.1
21 months: Average time from NOC to public reimbursement of drugs in Canada.1
22 months: Time from NOC to public reimbursement for orphan/rare-disease drugs.1
19 months: Time from NOC to public reimbursement for oncology drugs.1
43 days: Time from NOC to Alberta listing (on a case-by-case basis) of spinal muscular atrophy drug Zolgensma.2,3
Coming soon: new drugs that call for new thinking
35% Percentage of drugs in development that target cancer.4
40%: Percentage of pipeline drugs in pre-registration phase that target orphan/rare diseases.4
5: Number of gene therapies in the pipeline with breakthrough potential.4
Global access advantage
31%: Difference between public coverage in top OECD countries (96%) vs Canada (65%) for drugs that treat unmet needs.1
71: Number of innovative contracts in Italy, the global leader for OBAs.5
59%: Proportion of US payers that have executed at least one OBA. 6
Access innovation in Canada
16: Number of known innovative access contracts in Canada as of late 2017;7 the current figure could be significantly higher.
2: Number of OBAs with some publicly available information in Canada.8
37: Approximate number of annual diagnoses of SMA in Canada.9
5: Approximate number of annual diagnoses of SMA in Alberta,9 where eligible patients receive coverage for game-changing drug Zolgensma (the most expensive drug in the world)10 through an innovative access approach.11
Area of need
4,300 Number of Canadian patients with cystic fibrosis (CF) hoping to get access to novel CF medication Trikafta.12 EU and US patients have been able to access the medication for some time via managed entry agreements. 13
$300,000: Approximate annual cost of Trikafta.14
9.2: Additional years of life that Trikafta could make possible for children born with CF.15
References
Hoskyn SL. Explaining public reimbursement delays for new medicines for Canadian patients. Innovative medicines Canada. http://innovativemedicines.ca/wp-content/uploads/2020/06/20200630-CADTH-TTL-Poster-FINAL.pdf
Health Canada approves Zolgensma, the one-time treatment for pediatric patients with SMA. Cision. Dec. 16, 2020. https://www.newswire.ca/news-releases/health-canada-approves-zolgensma-r-the-one-time-gene-therapy-for-pediatric-patients-with-spinal-muscular-atrophy-sma-1-886604228.html
Alberta Zolgensma listing announcement. https://www.youtube.com/watch?v=BuHRfRZo9Wo&feature=emb_logo
Pipeline Monitor 2020. Patented Medicine Prices Review Board. https://www.canada.ca/content/dam/pmprb-cepmb/documents/npduis/analytical-studies/meds-pipeline-monitor/2020/MPM-2020-en.pdf
Designing the blueprint for pan-Canadian rare drug program. CORD virtual conference. Dec. 16, 2020. https://www.youtube.com/watch?v=OggDgpzqFBY
More than half of all health plans use outcomes-based contracts. Avalere press release. Oct. 1, 2019. https://avalere.com/press-releases/more-than-half-of-health-plans-use-outcomes-based-contracts
Innovative pharma contracts: when do value-based arrangements work? McKinsey & Company. Oct. 19, 2017. https://www.mckinsey.com/industries/pharmaceuticals-and-medical-products/our-insights/innovative-pharma-contracts-when-do-value-based-arrangements-work
20Sense original research.
Clinical review report: Nusinersen (Spinraza). CADTH. January 2018. https://www.ncbi.nlm.nih.gov/books/NBK533991/#cl1.s1.
Successful market access for gene therapies—strategic challenges and possible solutions. SKC Beratungsgesellschaft mbH 2020. https://skc-beratung.de/whitepaper/GentherapieWhitepaper_ENG.pdf
Families of Alberta children suffering from spinal muscular atrophy (SMA) may now be eligible to receive funding for gene replacement therapy treatment. Cure SMA news release. https://curesma.ca/2021/01/28/zolgensma/
It’s time to get loud for Canadians with cystic fibrosis. CF Get Loud. https://www.cfgetloud.ca/
Life-saving drugs FAQs. Cystic Fibrosis Trust. https://www.cysticfibrosis.org.uk/the-work-we-do/campaigning-hard/life-saving-drugs/life-saving-drugs-faqs
Georgieva K. Cystic Fibrosis Canada says “life-changing” drug coming to Canada, but approval months away. CBC News. Nov. 11, 2020. https://www.cbc.ca/news/canada/windsor/cystic-fibrosis-community-rejoicing-trikafta-1.5798421#:~:text=Trikafta%20costs%20roughly%20%24300%2C000%20US%20a%20year
Melamed D. Trikafta soon to be up for approval, Cystic Fibrosis Canada reporting. Cystic Fibrosis News Today. Nov. 13, 2020. https://cysticfibrosisnewstoday.com/2020/11/13/trikafta-expected-soon-up-for-health-canada-approval-cyctic-fibrosis-canada-says/