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Drug Shortage Lessons Learned: How do we build a more resilient injectable medicines market in Canada?

Written by Kevin Mohamed, Hospital Business Unit Lead, Pfizer Canada

Recently, I had the opportunity to participate in a public event organized by The Globe and Mail called the Drug Shortages Summit. The event included several stakeholders who all brought different and very valuable perspectives from their own experiences with critical drug shortages in Canada over the past few years. Here are some of my reflections following that event.

2020 proved to be a monumental and unprecedented year driven by the international and Canadian response to the COVID-19 pandemic. This mobilization brought to the forefront the critical role our hospitals and frontline healthcare workers play in patient care.  Canadians across the country were galvanized by scenes of our hospitals, with many of our fellow citizens in intensive care units being treated for the complications of this virus.

It also highlighted the importance of having a robust and reliable supply of critical injectable medicines to meet the needs of healthcare providers and their patients. Pfizer is proud of the role we have played in partnering with the hospital network across the country.

Drug shortages can present a significant negative impact on the quality of patient care in Canada. So much so that a 2012 motion in the House of Commons by the Standing Committee on Health called for the need for concentrated effort by all stakeholders to develop a pan-Canadian strategy to anticipate, mitigate and manage drug shortages in Canada.[i] Despite improvements, including requirements for public shortage notifications, solutions to the underlying problems remain elusive. Most shortages continue to fall under the category of injectables, that is, complex medicines that are the cornerstone of critical care in hospitals and other settings. There are a diverse range of both ready to use and surgical therapies available that are vital in the treatment of patients with both chronic and life-threatening illnesses.[ii]

Shortages of injectables are driven by manufacturing and regulatory challenges and dated procurement models. The manufacturing process is costly and requires sophisticated equipment to ensure high quality standards. Over the last few years we have taken internal action at Pfizer to resolve manufacturing issues by ramping up production and supply, hiring thousands of people around the world and investing $800 million to enhancing our injectable global manufacturing network, with another $1.3 - $1.4 billion globally intended to add capacity, modernize lines and speed up inspections over the next five years.

We remain committed to the injectables market and the health providers and patients who rely on these medicines. However, the current procurement model commoditizes these complex injectable medicines and prioritizes, above all else, sourcing these medicines at the lowest cost possible. Reducing healthcare costs is important for all stakeholders. Unfortunately, the emphasis on the lowest price has unintended consequences, including limiting the number of manufacturers who can supply these products and failing to reward companies that invest in developing innovative technology, improving quality of output and increasing manufacturing capabilities, all of which come at a cost. Over the years, multiple manufacturers have even left the Canadian market due to the uncertainty of cost recovery.[iii]

The current system requires a shift away from the price-above-all-else model to one that puts patient care first. Outdated procurement practices do not fit within the current movement toward value-based healthcare decision-making, which links healthcare costs to the quality of patient outcomes and experiences, including in hospitals where there is a concerted effort to put patients at the centre of care pathways.[iv],[v] The current procurement model clearly does not reflect the true value injectable medicines bring to the public health care system and the patients who depend on them.

Our objective is to help evolve a more predictable market for both suppliers and purchasers. Fair and balanced contract terms and conditions centred around value will ultimately lead to better continuity and cost-effectiveness for health care providers and patients alike. The COVID-19 pandemic has also shown the need for a market that is flexible and can react to rapidly changing conditions. These changes would put Canada’s healthcare system on a stronger footing and avoid expensive fixes to unexpected emergencies that put patients at risk.

Pfizer is advocating for reasonable changes to Group Purchasing Organization (GPO) procurement practices that would help foster a more equitable and resilient market, including sustainable pricing and diversity of supply. Incorporating greater transparency in discussions on terms and conditions, as well as thorough risk/benefit analyses, could lead to a more robust and reliable injectable market for years to come.

It is now 2021, nearly nine years after the Standing Committee adopted the motion on drug shortages and in the midst of a global pandemic, progress has been made but the healthcare community continues to grapple with these issues.[vi]  We recognize that there is not one single solution or stakeholder that can solve this problem, but we must work collaboratively towards solutions that favour value for patients and the system overall. For such a discussion to happen we need willing partners. Pfizer Canada calls upon the different stakeholders involved in procurement practices to work with us toward ending drug shortages in Canada.

[i] House of Commons Standing Committee on Health. 2012. Drug Supply in Canada: A Multi-stakeholder Responsibility, p. 2 & 15.

[ii] Persistence Market Research. 2017. Global Market Study on Sterile Injectable Drugs: Cancer Application Segment to Significantly Contribute to the Growth of the Global Market During 2017 – 2025, Abstract. https://www.persistencemarketresearch.com/market-research/sterile-injectable-drugs-market.asp. Accessed January 5, 2021.

[iii] C.D. Howe Institute. 2018. Commentary No. 515: Assessing Canada’s Drug Shortage Problem. https://www.cdhowe.org/sites/default/files/attachments/research_papers/mixed/Commentary_515.pdf, p.22. Accessed January 4, 2021.

[iv] Canadian Foundation for Healthcare Improvement. 2018. Aligning Outcomes and Spending: Canadian Experiences with Value-Based Healthcare, p.11. https://www.cfhi-fcass.ca/docs/default-source/itr/tools-and-resources/vbhc/vbhc-executive-brief-e. Accessed December 22, 2020.

[v] Mangan, B. and Ludbrook, M, NHS North West Procurement Development. 2018. Value based procurement: An alternative approach to total cost reduction, improved efficiency and enhanced patient outcomes in the NHS - ‘A framework for delivery’, p.3. https://scanhealth.ca/scan/images/news/VBPGuide.pdf. Accessed January 8, 2021.

[vi] House of Commons Standing Committee on Health. 2012. Drug Supply in Canada: A Multi-stakeholder Responsibility, p. 2 & 15.