Issue link: http://clhia.uberflip.com/i/406567
17 province's public drug plan. Ontario has been a leader in this regard. For instance, from 2006-07 through to 2011-12, the province has negotiated roughly 175 PLAs with manufacturers. In addition, as of 2011, through the Council of the Federation's pan-Canadian bulk buying alliance, the provinces have collaborated on negotiating PLAs for 9 new drugs and an additional 18 are currently under negotiation. PLAs are problematic for a number of reasons. First, they are confidential and end up pitting public plans against each other for better pricing. Second, this process disadvantages private plans and those paying out-of-pocket by ultimately keeping prices high for those purchasing their drug privately. Finally, the effective price for a drug after the PLA is negotiated, can result in the Minister making different cost-benefit listing decisions than what was recommended by the CDR/pCODR/INESSS reviews. This is a particularly challenging issue for private payers in Quebec (and likely New Brunswick going forward) because Quebec mandates a standard drug formulary that all private insurers must offer even though the private payer may not benefit from any reduced pricing. It is important to note that competition law restrictions make it very challenging for private payers to work together to enter into agreements similar to PLAs. The Canadian life and health insurance industry feels strongly that there should be only one price for a prescription drug for Canadians regardless of whether they have public coverage, private coverage or are paying out-of-pocket. Any divergence from this fundamental principle creates a situation where Canadians are treated differently, and may have different access to drugs, with no basis in sound public policy. As noted earlier in the paper, we believe fundamental reform to how PMPRB sets prices is required. We would note that a more market-based approach to setting prices will reduce the need for PLAs as the PMPRB price would already reflect market and economic factors. However, to the degree that PLAs continue to be used by the provinces in Canada, we believe that they should equally benefit private payers and Canadians paying out-of-pocket.