{"id":13382,"date":"2022-05-02T12:46:08","date_gmt":"2022-05-02T12:46:08","guid":{"rendered":"https:\/\/laforcedmd.com\/go-further-who-decides-to-reimburse-drug-costs\/"},"modified":"2022-10-27T19:29:03","modified_gmt":"2022-10-27T19:29:03","slug":"go-further-who-decides-to-reimburse-drug-costs","status":"publish","type":"page","link":"https:\/\/laforcedmd.com\/en\/go-further-who-decides-to-reimburse-drug-costs\/","title":{"rendered":"Go further &#8211; Who decides to reimburse drug costs?"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[mk_page_section vertical_align=&#8221;center&#8221; bg_image=&#8221;https:\/\/laforcedmd.com\/wp-content\/uploads\/2022\/06\/img-la-force-dmd-19.jpg&#8221; bg_position=&#8221;center center&#8221; bg_repeat=&#8221;no-repeat&#8221; bg_stretch=&#8221;true&#8221; enable_3d=&#8221;true&#8221; min_height=&#8221;250&#8243; full_height=&#8221;true&#8221; el_class=&#8221;section-header header-02&#8243; sidebar=&#8221;sidebar-1&#8243;][vc_column][vc_column_text disable_pattern=&#8221;false&#8221; align=&#8221;center&#8221; css=&#8221;.vc_custom_1653673400308{margin-bottom: 0px !important;}&#8221;]\n<h1><span class=\"titre-beige\">Who decides to reimburse<\/span><br \/>\n<span class=\"titre-jaune\">Who decides whether or not to<\/span><\/h1>\n[\/vc_column_text][\/vc_column][\/mk_page_section][vc_row][vc_column][mk_padding_divider size=&#8221;75&#8243;][vc_column_text disable_pattern=&#8221;false&#8221; align=&#8221;center&#8221; el_class=&#8221;contenu-inner-padding&#8221; css=&#8221;.vc_custom_1654196825443{margin-bottom: 0px !important;}&#8221;]\n<h2>Here\u2019s a look at <span class=\"titre-jaune\">how things work.<\/span><\/h2>\n[\/vc_column_text][mk_padding_divider size=&#8221;75&#8243;][\/vc_column][\/vc_row][vc_row fullwidth=&#8221;true&#8221; css=&#8221;.vc_custom_1650899369675{padding-right: 0px !important;padding-left: 0px !important;}&#8221;][vc_column css=&#8221;.vc_custom_1650899375035{padding-right: 0px !important;padding-left: 0px !important;}&#8221;][vc_accordions style=&#8221;simple-style&#8221; container_bg_color=&#8221;&#8221; responsive=&#8221;false&#8221; scroll_click=&#8221;true&#8221; el_class=&#8221;liste-accordion liste-remboursement accordion-hide-title&#8221;][vc_accordion_tab title=&#8221;&lt;\/p&gt;<br \/>\n&lt;h2&gt;Who decides to reimburse drug costs?&lt;\/h2&gt;<br \/>\n&lt;p&gt;&#8221;][vc_row_inner el_class=&#8221;border-section&#8221; css=&#8221;.vc_custom_1651495804444{padding-right: 0px !important;padding-left: 0px !important;}&#8221;][vc_column_inner el_class=&#8221;bg-height-02&#8243; width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1654197319081{padding-right: 0px !important;padding-left: 0px !important;background-image: url(https:\/\/laforcedmd.com\/wp-content\/uploads\/2022\/05\/img-la-force-dmd-20.jpg?id=11349) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221;][\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243;][vc_column_text disable_pattern=&#8221;false&#8221; el_class=&#8221;contenu-inner-padding&#8221; css=&#8221;.vc_custom_1654196849359{margin-bottom: 0px !important;}&#8221;]\n<h2>Who decides to <span class=\"titre-jaune\">reimburse drug costs?<\/span><\/h2>\n<p>After a new drug receives a Notice of Compliance (NOC) and Drug Identification Number (DIN) from Health Canada, a pharmaceutical company can ask provincial or territorial drug insurance plans to reimburse the cost of a new drug. Participating drug plans may also submit requests.<\/p>\n<p>Here\u2019s a look at how things work. First, it\u2019s worth mentioning that each province and territory in Canada has its own drug reimbursement plan.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_accordion_tab][vc_accordion_tab title=&#8221;&lt;\/p&gt;<br \/>\n&lt;h3&gt;Across Canada&lt;\/h3&gt;<br \/>\n&lt;p&gt;&#8221;][vc_row_inner is_fullwidth_content=&#8221;false&#8221;][vc_column_inner][mk_padding_divider size=&#8221;75&#8243;][vc_column_text disable_pattern=&#8221;false&#8221; el_class=&#8221;contenu-inner-padding&#8221; css=&#8221;.vc_custom_1654805335477{margin-bottom: 0px !important;}&#8221;]\n<h3 class=\"center\">Across <span class=\"titre-jaune\">Canada<\/span><\/h3>\n<p>In all Canadian provinces and territories, except Quebec (see below), the Canadian Agency for Drugs and Technologies in Health (CADTH), through the Common Drug Review (CDR) process, decides whether or not to recommend the public reimbursement of new drug costs. (A different process is used for new cancer drugs.) This review process takes 180 days or longer.<\/p>\n<p class=\"txt-style2 title-margin\">Step 1<\/p>\n<p>A pharmaceutical company or provincial or territorial drug plan submits its request for a Common Drug Review to CADTH.<\/p>\n<p class=\"txt-style2 title-margin\">Step 2<\/p>\n<p>During the CDR process, the Canadian Drug Expert Committee (CDEC) conducts a rigorous, objective evaluation of the drug\u2019s clinical and economic benefits and drawbacks. It then makes a recommendation to federal, provincial and territorial drug insurance plans (except Quebec) to:<\/p>\n<ul class=\"liste\">\n<li>Reimburse drug costs<\/li>\n<li>Reimburse drug costs under specific conditions<\/li>\n<li>Not reimburse drug costs.<\/li>\n<\/ul>\n<p class=\"txt-style2 title-margin\">Step 3<\/p>\n<p>Participating drug plans in each province and territory then decide whether to include the new drug on their formulary \u2013 a master list of reimbursable drugs \u2013 based on this recommendation. However, CDR recommendations are not binding, and individual provinces and territories may decide not to list a recommended drug or, on the other hand, to list a not-recommended drug. Each province and territory makes the final decision on whether or not to cover drug costs.<\/p>\n<p class=\"txt-style2 title-margin\">Step 4<\/p>\n<p>Participating drug plans in each province and territory (except Quebec) then decide on a reimbursement strategy for the new drug. For example, will their drug plan cover all, none or a percentage of drug costs?<\/p>\n<p><strong>What you need to know<\/strong><\/p>\n<p>The Canadian Drug Expert Committee considers the following information when issuing recommendations and advice:<\/p>\n<p><strong>Patient group input<\/strong><\/p>\n<ul class=\"liste\">\n<li>Clinical trial evidence for drug safety and efficacy<\/li>\n<li>Therapeutic benefits and drawbacks<\/li>\n<li>Cost and cost-effectiveness vs. currently accepted therapies<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p class=\"txt-style2 center\">Learn more<\/p>\n<div class='wrap-btn-fleche '><a href='https:\/\/www.cadth.ca\/fr\/media\/cdr\/process\/CDR_Procedure.pdf' class='btn-fleche cursor-target'  target='_blank'><\/a><\/div>\n[\/vc_column_text][mk_padding_divider size=&#8221;75&#8243;][\/vc_column_inner][\/vc_row_inner][\/vc_accordion_tab][vc_accordion_tab title=&#8221;&lt;\/p&gt;<br \/>\n&lt;h3&gt;Quebec&lt;\/h3&gt;<br \/>\n&lt;p&gt;&#8221;][vc_row_inner is_fullwidth_content=&#8221;false&#8221;][vc_column_inner][mk_padding_divider size=&#8221;75&#8243;][vc_column_text disable_pattern=&#8221;false&#8221; el_class=&#8221;contenu-inner-padding&#8221; css=&#8221;.vc_custom_1654805320658{margin-bottom: 0px !important;}&#8221;]\n<h3 class=\"center\"><span class=\"titre-jaune\">Quebec<\/span><\/h3>\n<p>The Institut national d\u2019excellence en sant\u00e9 et en services sociaux (INESSS) is responsible for evaluating new drugs in Quebec. This agency recommends whether or not to list a new drug in the Quebec drug insurance plan for reimbursement. Drugs must first receive Health Canada approval and have a DIN number. This process takes about one year.<\/p>\n<p class=\"txt-style2 title-margin\">Step 1<\/p>\n<p>A pharmaceutical company submits an application to the institute. Members of INESSS, the Comit\u00e9 Scientifique permanent de l\u2019\u00e9valuation des medicaments aux fins d\u2019inscription (Standing Scientific Committee for Medication Evaluation), and outside experts review the application.<\/p>\n<p class=\"txt-style2 title-margin\">Step 2<\/p>\n<p>The committee submits a report to the INESSS Board of Directors, which ratifies the recommendation.<\/p>\n<p class=\"txt-style2 title-margin\">Step 3<\/p>\n<p>INESSS publishes a Notice to the Minister, which lists its recommendation. This notice is sent to the Quebec Minister of Health and Social Services. It explains the reasons for recommending a drug\u2019s acceptance or rejection for reimbursement, in accordance with Quebec law.<\/p>\n<p class=\"txt-style2 title-margin\">Step 4<\/p>\n<p>The Minister approves or rejects INESSS\u2019 recommendation.<\/p>\n<p class=\"txt-style2 title-margin\">\u00c9tape 5<\/p>\n<p>If a new drug receives the Minister\u2019s approval, the R\u00e9gie de l\u2019assurance maladie du Qu\u00e9bec (RAMQ) updates the List of Medications to be reimbursed by the province\u2019s drug insurance plan.<\/p>\n<p class=\"txt-style2 center\">Learn more<\/p>\n<div class='wrap-btn-fleche '><a href='https:\/\/www.inesss.qc.ca\/accueil.html' class='btn-fleche cursor-target' ><\/a><\/div>\n[\/vc_column_text][mk_padding_divider size=&#8221;75&#8243;][\/vc_column_inner][\/vc_row_inner][\/vc_accordion_tab][vc_accordion_tab title=&#8221;&lt;\/p&gt;<br \/>\n&lt;h3&gt;Exceptions for drug reimbursement&lt;\/h3&gt;<br \/>\n&lt;p&gt;&#8221;][vc_row_inner][vc_column_inner el_class=&#8221;bg-height-01&#8243; width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1654805429572{padding-top: 0px !important;padding-right: 0px !important;padding-bottom: 0px !important;padding-left: 0px !important;background-image: url(https:\/\/laforcedmd.com\/wp-content\/uploads\/2022\/06\/img-la-force-dmd-54.jpg?id=11773) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221;][\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243;][vc_column_text disable_pattern=&#8221;false&#8221; el_class=&#8221;smaller-inner-padding&#8221; css=&#8221;.vc_custom_1654197153591{margin-bottom: 0px !important;}&#8221;]\n<h3>Exceptions for <span class=\"titre-jaune\">drug reimbursement<\/span><\/h3>\n<p>Many provinces and territories, including Quebec, will consider covering the cost of a drug that has received Health Canada approval under certain circumstances. Your doctor can advise you and help to determine whether you qualify for drug reimbursement.<\/p>\n<p>He or she can help you to fill out a special form to apply for reimbursement if you qualify.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_accordion_tab][\/vc_accordions][\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[mk_page_section vertical_align=&#8221;center&#8221; bg_image=&#8221;https:\/\/laforcedmd.com\/wp-content\/uploads\/2022\/06\/img-la-force-dmd-19.jpg&#8221; bg_position=&#8221;center center&#8221; bg_repeat=&#8221;no-repeat&#8221; bg_stretch=&#8221;true&#8221; enable_3d=&#8221;true&#8221; min_height=&#8221;250&#8243; full_height=&#8221;true&#8221; el_class=&#8221;section-header header-02&#8243; sidebar=&#8221;sidebar-1&#8243;][vc_column][vc_column_text disable_pattern=&#8221;false&#8221; align=&#8221;center&#8221; css=&#8221;.vc_custom_1653673400308{margin-bottom: 0px !important;}&#8221;] Who decides to reimburse Who decides whether or not to [\/vc_column_text][\/vc_column][\/mk_page_section][vc_row][vc_column][mk_padding_divider size=&#8221;75&#8243;][vc_column_text disable_pattern=&#8221;false&#8221; align=&#8221;center&#8221; el_class=&#8221;contenu-inner-padding&#8221; css=&#8221;.vc_custom_1654196825443{margin-bottom: 0px !important;}&#8221;] Here\u2019s a look at how things work. [\/vc_column_text][mk_padding_divider size=&#8221;75&#8243;][\/vc_column][\/vc_row][vc_row fullwidth=&#8221;true&#8221; css=&#8221;.vc_custom_1650899369675{padding-right: 0px !important;padding-left: 0px !important;}&#8221;][vc_column css=&#8221;.vc_custom_1650899375035{padding-right: 0px !important;padding-left: 0px [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-13382","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>La Force | Who decides to reimburse drug costs?<\/title>\n<meta name=\"description\" content=\"Who decides to reimburse drug costs? 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