Issue link: http://clhia.uberflip.com/i/406567
16 3. THE INSTITUT NATIONAL D'EXCELLENCE EN SANTÉ ET EN SERVICES SOCIAUX (INESSS) In Quebec, INESSS conducts the evaluation of new drugs. The review does a cost-benefit analysis and recommendations for public funding are based on effectiveness and cost considerations. INESSS recommends which new drugs should be covered under RAMQ (and by extension private plans) in Quebec. Once these recommendations are received by the provincial Ministers of Health, the provinces conduct an additional review with their own expert committees. These committees typically consider the drug's clinical value, patient and social impact, public and patient input and CDR/pCODR/INESSS recommendations. Ultimately, any decision to list a drug rests with the Minister in each province. It is at this stage that often the province enters into negotiations with the drug manufacturer on what are referred to as PLAs. As we discuss in section b.2.2 below, these agreements establish a confidential, lower, volume-based price for public plans. Finally, as we mentioned above, this review process only begins after the Health Canada and PMPRB approval processes are complete. We believe that there is scope for the CDR/pCODR/INESSS to start their cost-benefit analysis earlier, potentially in parallel with Health Canada and PMPRB's reviews, as a means to accelerate the availability of new drugs for Canadians. THEREFORE, THE CLHIA RECOMMENDS THAT: • THE CDR/PCODR/INESSS PURSUE OPPORTUNITIES TO RUN THEIR ASSESSMENTS IN PARALLEL WITH HEALTH CANADA AND PMPRB'S REVIEWS IN ORDER TO ACCELERATE THE AVAILABILITY OF INNOVATIVE DRUGS FOR CANADIANS. b.2.1 Product Listing Agreements (PLAs) In an effort to control health care costs, PLAs are increasingly being used by provincial governments. PLAs are confidential, often volume based, agreements between the province and the drug manufacturer that establish the true effective price for a particular drug for the