This document discusses the private payer market for prescription drugs in Canada. It provides data on prescription drug spending by payer type across different Canadian regions in 2014. The private market accounts for 22-48% of drug spending across regions. The document also outlines the drug development, review, pricing and reimbursement process in Canada as well as the role of private drug plans and provincial plans. It notes that employer drug plans are important since diseases can impact productivity at work both physically and mentally.

1. UnderstandingThe Private Payer
Market in Canada
April 13, 2016
GLENN MONTEITH
Vice President, Innovation & Health Sustainability
Vice-président, Innovation et viabilité des soins de santé

2. 2Our Members

3. Medicines In Development 3

4. The Sustainability Balance
Source:CIHI, (NHEX, Series G—Expenditure on Drugs byType, by Source of Finance, by Province/Territory and Canada); 2014.And, IMS
Brogan Pharmastat Plus, to estimate cash market share in each individual province.
- DIF Premium=Drug Insurance Funds (Premium Component). WCB=Workers Compensation Board.
- Public includes both provincial drug plans and Federal drug plans. Federal includes NIHB,VeteransAffairs, Correctional Service,Canadian
Forces, and Interim Federal Health Program (for refugees).
39%
64%
33%
47%
36%
46%
32%
41%
4%
14%
35%
22%
48%
24%
31%
36%
33%
37%
22%
14%
18%
28%
32%
18%
22%
21%
28,718
70
2,058
1,726
2,771
2,999
7,852
11,241
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Canada
3 Terr
4 Atl
Prov
MB & SK
BC
AB
QC
ON
$, millionsPrescription Drug Spending by PayerType, by Region, 2014
Public WCB DIF Premium (QC only) Private Insurer Out of pocket

5. Drug Development
Health Canada
Review
Patented Medicine
Prices Review Board
Health Technology
Assessment
Hospitals
Patient Access
Canadian Pathway to Patient Access
Private Drug Plans
Provincial Drug
Plans

6. Employer Plans Matter – So How to Capture the ROI 6
Diseases affect productivity at work, both physically and/or mentally
Examples:
1 Source: http://www.phac-aspc.gc.ca/media/nr-rp/2011/2011_0919-bg-di-eng.php
2 Source: Cranswick K., Dosman D. Eldercare: Canadian Social Trends. 2008, Vol. 86, pp. 48-56 and Fast, et al. A Profile of Canadian Chronic Care
Providers: A Report Submitted to Human Resources and Development Canada. Univ. of Alberta. Edmonton : s.n., 2002.