(202) Fear of Missing Out: Drug Availability in Canada versus the USA

Background: Per-capita drug spending in the USA is double that in Canada. One commonly-debated point is whether this allows increased access to valuable therapies.

Objectives: To determine if Canadians lack access to drugs with major additional therapeutic value compared to available drugs.

Methods: We used IQVIA Multinational Integrated Data Analysis (MIDAS) data to determine drugs purchased in the USA but not in Canada from 2017 to 2021. Using Health Canada’s Drug Product Database (DPD) and clinical review, we categorized the drugs into 8 mutually exclusive groups: DPD listing status (“cancelled post-market” or “dormant, approved, or cancelled pre-market”), other drug alternatives available (“formulation unavailable,” “existing drug class,” or “therapeutically similar”), “pre-approval,” “atypical access available,” or “unavailable” in Canada. Therapeutic value assessments of “unavailable” drugs were obtained from Prescrire International, Haute Autorité de Santé, and the Institute for Quality and Efficiency in Health Care.

Results: Our analysis included 399 drugs: 120 (30%) were “cancelled post-market”; 38 (10%) were “dormant, approved, or cancelled pre-market”; 49 (12%) were “formulation unavailable”; 130 (33%) were “existing drug class”; 35 (9%) were “therapeutically similar”; 3 (1%) were “pre-approval”; 15 (4%) were “atypical access available”; and 9 (2%) were “unavailable” in Canada. Six of the 9 “unavailable” drugs had been evaluated by one or more organizations, and were rated as offering minor to no therapeutic value.

Conclusions: There was similar access to important drug therapies in Canada and the USA. Further work is needed to better understand the therapeutic impact of the drugs unavailable in Canada.