{"version":"1.0.0","segments":[{"startTime":0.72,"endTime":3.393,"body":"- Welcome to this Mtech Access webinar."},{"startTime":4.35,"endTime":7.5,"body":"At Mtech Access we"},{"startTime":4.35,"endTime":7.5,"body":"provide health economics"},{"startTime":7.5,"endTime":10.68,"body":"and outcomes research and"},{"startTime":7.5,"endTime":10.68,"body":"market access services,"},{"startTime":10.68,"endTime":13.263,"body":"from strategy, through to implementation."},{"startTime":14.58,"endTime":18.69,"body":"Get in touch today to discuss"},{"startTime":14.58,"endTime":18.69,"body":"your market access goals."},{"startTime":18.69,"endTime":21.54,"body":"First, though, I hope"},{"startTime":18.69,"endTime":21.54,"body":"you enjoy the webinar."},{"startTime":21.54,"endTime":23.4,"body":"Hello, welcome everyone to our latest"},{"startTime":23.4,"endTime":25.26,"body":"Global Whispers webinar."},{"startTime":25.26,"endTime":28.2,"body":"Please see our YouTube"},{"startTime":25.26,"endTime":28.2,"body":"channel for past webinars"},{"startTime":28.2,"endTime":31.59,"body":"and look out for more content"},{"startTime":28.2,"endTime":31.59,"body":"from us in the future."},{"startTime":31.59,"endTime":33.72,"body":"The topic today is market access"},{"startTime":33.72,"endTime":36.24,"body":"and reimbursement in Canada."},{"startTime":36.24,"endTime":39.54,"body":"I'm Clare Foy, director"},{"startTime":36.24,"endTime":39.54,"body":"of Global Market Access"},{"startTime":39.54,"endTime":41.43,"body":"here at Mtech Access."},{"startTime":41.43,"endTime":43.74,"body":"We have a great mix of audience today"},{"startTime":43.74,"endTime":46.86,"body":"across industry and healthcare systems."},{"startTime":46.86,"endTime":49.38,"body":"I'd like to particularly"},{"startTime":46.86,"endTime":49.38,"body":"welcome our global affiliate"},{"startTime":49.38,"endTime":52.673,"body":"partners who play a key"},{"startTime":49.38,"endTime":52.673,"body":"role in the work that we do."},{"startTime":52.673,"endTime":56.1,"body":"For those of you that"},{"startTime":52.673,"endTime":56.1,"body":"don't know us very well,"},{"startTime":56.1,"endTime":59.49,"body":"Mtech Access is a global"},{"startTime":56.1,"endTime":59.49,"body":"specialist health economics,"},{"startTime":59.49,"endTime":62.67,"body":"outcomes, and market access consultancy."},{"startTime":62.67,"endTime":64.98,"body":"With a track record and expert delivery,"},{"startTime":64.98,"endTime":67.59,"body":"we provide specialist"},{"startTime":64.98,"endTime":67.59,"body":"support to pharmaceutical"},{"startTime":67.59,"endTime":70.98,"body":"and medtech clients, and we"},{"startTime":67.59,"endTime":70.98,"body":"work as a collaborative partner"},{"startTime":70.98,"endTime":73.083,"body":"to healthcare systems worldwide."},{"startTime":74.1,"endTime":76.41,"body":"Today we're going to"},{"startTime":74.1,"endTime":76.41,"body":"focus on market access"},{"startTime":76.41,"endTime":78.39,"body":"and reimbursement in Canada,"},{"startTime":78.39,"endTime":81.33,"body":"and I'm delighted to welcome"},{"startTime":78.39,"endTime":81.33,"body":"our guest, Don Husereau."},{"startTime":81.33,"endTime":82.26,"body":"Welcome, Don."},{"startTime":82.26,"endTime":83.64,"body":"Could you please take a moment"},{"startTime":83.64,"endTime":85.833,"body":"to introduce yourself and your background?"},{"startTime":87.72,"endTime":89.28,"body":"- Hi, thanks, and thanks for having me"},{"startTime":89.28,"endTime":91.14,"body":"and inviting me to this."},{"startTime":91.14,"endTime":92.29,"body":"Yeah, I'm Don Husereau."},{"startTime":93.42,"endTime":95.7,"body":"I work in and out of Ottawa."},{"startTime":95.7,"endTime":99.42,"body":"I have an adjunct appointment"},{"startTime":95.7,"endTime":99.42,"body":"at the University of Ottawa,"},{"startTime":99.42,"endTime":100.44,"body":"the School of Medicine."},{"startTime":100.44,"endTime":102.57,"body":"I am originally a pharmacist by training,"},{"startTime":102.57,"endTime":105.33,"body":"but I worked with the"},{"startTime":102.57,"endTime":105.33,"body":"Canadian Agency for Drugs"},{"startTime":105.33,"endTime":109.3,"body":"and Technologies and Health"},{"startTime":105.33,"endTime":109.3,"body":"for 10 years where I received"},{"startTime":110.22,"endTime":112.41,"body":"substantial training in"},{"startTime":110.22,"endTime":112.41,"body":"health technology assessment,"},{"startTime":112.41,"endTime":114.3,"body":"health economic evaluation."},{"startTime":114.3,"endTime":119.3,"body":"And I have been, for the"},{"startTime":114.3,"endTime":119.3,"body":"last more than 10 years,"},{"startTime":119.49,"endTime":123.06,"body":"conducting independent health policy,"},{"startTime":123.06,"endTime":124.74,"body":"health services research,"},{"startTime":124.74,"endTime":129.18,"body":"and I've been a health"},{"startTime":124.74,"endTime":129.18,"body":"economist advising payers"},{"startTime":129.18,"endTime":132.51,"body":"on several national and"},{"startTime":129.18,"endTime":132.51,"body":"regional committees,"},{"startTime":132.51,"endTime":134.01,"body":"and I'm very happy to be here."},{"startTime":135.21,"endTime":136.11,"body":"- Brilliant, thank you."},{"startTime":136.11,"endTime":137.94,"body":"We're really glad to have you."},{"startTime":137.94,"endTime":141.24,"body":"So could we start by talking"},{"startTime":137.94,"endTime":141.24,"body":"a bit about the Canadian"},{"startTime":141.24,"endTime":144.21,"body":"healthcare system in general,"},{"startTime":141.24,"endTime":144.21,"body":"and perhaps you could outline"},{"startTime":144.21,"endTime":146.82,"body":"some of the challenges of achieving access"},{"startTime":146.82,"endTime":149.463,"body":"for a pharma or medtech product in Canada?"},{"startTime":152.67,"endTime":153.69,"body":"- Yeah."},{"startTime":153.69,"endTime":157.113,"body":"Well, Canadian health system's"},{"startTime":153.69,"endTime":157.113,"body":"a federated health system."},{"startTime":160.03,"endTime":161.46,"body":"So it's a bit tricky."},{"startTime":161.46,"endTime":165.677,"body":"We have 10 provinces,"},{"startTime":165.677,"endTime":169.68,"body":"and we have territories, and"},{"startTime":165.677,"endTime":169.68,"body":"they have an independent remit"},{"startTime":169.68,"endTime":173.1,"body":"to delivery healthcare,"},{"startTime":169.68,"endTime":173.1,"body":"in a similar fashion,"},{"startTime":173.1,"endTime":175.15,"body":"under federal legislation that says"},{"startTime":176.19,"endTime":180.15,"body":"that there's money at"},{"startTime":176.19,"endTime":180.15,"body":"stake if they deliver it"},{"startTime":180.15,"endTime":182.043,"body":"using certain guiding principles."},{"startTime":183.18,"endTime":186.81,"body":"Under that, there's no mention of drugs"},{"startTime":186.81,"endTime":191.81,"body":"or publicly insured"},{"startTime":186.81,"endTime":191.81,"body":"community-based drug funding."},{"startTime":191.822,"endTime":195.48,"body":"But most provinces have"},{"startTime":191.822,"endTime":195.48,"body":"sort of recognised the need"},{"startTime":195.48,"endTime":197.11,"body":"and have created independent"},{"startTime":198.84,"endTime":203.73,"body":"agencies or insurance plans for drugs,"},{"startTime":203.73,"endTime":205.56,"body":"but they vary by province by province."},{"startTime":205.56,"endTime":208.47,"body":"So, what we see in Canada is a lot of them"},{"startTime":208.47,"endTime":211.17,"body":"have come up with similar"},{"startTime":208.47,"endTime":211.17,"body":"systems, or have similar coverage,"},{"startTime":211.17,"endTime":214.62,"body":"for example social welfare or seniors,"},{"startTime":214.62,"endTime":219.62,"body":"and they've gotten together"},{"startTime":214.62,"endTime":219.62,"body":"and created federated alliances"},{"startTime":220.17,"endTime":225.17,"body":"for both the review of"},{"startTime":220.17,"endTime":225.17,"body":"drugs and the pricing"},{"startTime":225.39,"endTime":226.893,"body":"and reimbursement of drugs."},{"startTime":228.3,"endTime":233.04,"body":"Quebec has its own systems of evaluation,"},{"startTime":233.04,"endTime":236.13,"body":"but does participate in alliances"},{"startTime":236.13,"endTime":238.92,"body":"related to getting price deals."},{"startTime":238.92,"endTime":240.45,"body":"I guess we'll talk about that a bit later."},{"startTime":240.45,"endTime":243.1,"body":"So yeah, when we think of"},{"startTime":240.45,"endTime":243.1,"body":"Canada we have to think of,"},{"startTime":244.14,"endTime":245.31,"body":"there's no national anything."},{"startTime":245.31,"endTime":248.28,"body":"It's not like the UK, for example."},{"startTime":248.28,"endTime":250.74,"body":"It's a little more maybe"},{"startTime":248.28,"endTime":250.74,"body":"like Italy or Spain"},{"startTime":250.74,"endTime":254.01,"body":"where you have a bunch"},{"startTime":250.74,"endTime":254.01,"body":"of different regions"},{"startTime":254.01,"endTime":255.46,"body":"who are trying to coordinate."},{"startTime":257.43,"endTime":258.93,"body":"- Okay."},{"startTime":258.93,"endTime":261.27,"body":"And obviously it's an HTA market,"},{"startTime":261.27,"endTime":263.31,"body":"you mentioned CADTH in your introduction."},{"startTime":263.31,"endTime":265.17,"body":"Could you tell us a"},{"startTime":263.31,"endTime":265.17,"body":"bit more about the role"},{"startTime":265.17,"endTime":268.833,"body":"of CADTH currently in"},{"startTime":265.17,"endTime":268.833,"body":"making HTA recommendations?"},{"startTime":270.03,"endTime":272.07,"body":"- Yeah, it's an HTA market,"},{"startTime":272.07,"endTime":274.96,"body":"and I think that sometimes"},{"startTime":272.07,"endTime":274.96,"body":"gets a bit misunderstood"},{"startTime":276.36,"endTime":278.85,"body":"because CADTH does review drugs,"},{"startTime":278.85,"endTime":281.31,"body":"they look at clinical cost"},{"startTime":278.85,"endTime":281.31,"body":"effectiveness, other dimensions."},{"startTime":281.31,"endTime":283.86,"body":"They also review medical devices"},{"startTime":283.86,"endTime":285.72,"body":"and procedures, other things."},{"startTime":285.72,"endTime":288.0,"body":"There are some"},{"startTime":285.72,"endTime":288.0,"body":"commercialised technologies,"},{"startTime":288.0,"endTime":293.0,"body":"like vaccines that are reviewed"},{"startTime":288.0,"endTime":293.0,"body":"by other HTA organisations."},{"startTime":294.48,"endTime":297.48,"body":"CADTH now does look at new blood products"},{"startTime":297.48,"endTime":302.48,"body":"for our national blood programme."},{"startTime":302.61,"endTime":307.61,"body":"Again, so CADTH is doing this"},{"startTime":307.95,"endTime":310.05,"body":"looking at, as I said,"},{"startTime":307.95,"endTime":310.05,"body":"clinical cost effectiveness,"},{"startTime":310.05,"endTime":312.87,"body":"looking at patient and"},{"startTime":310.05,"endTime":312.87,"body":"caregiver experiences,"},{"startTime":312.87,"endTime":314.73,"body":"and some other dimensions."},{"startTime":314.73,"endTime":319.087,"body":"I guess the confusion comes"},{"startTime":314.73,"endTime":319.087,"body":"in when manufacturers say,"},{"startTime":319.087,"endTime":323.01,"body":"\"Well, it's an HTA market,"},{"startTime":319.087,"endTime":323.01,"body":"it must be like the UK.\""},{"startTime":323.01,"endTime":325.95,"body":"But in fact we're, we're much"},{"startTime":323.01,"endTime":325.95,"body":"more like France and Germany."},{"startTime":325.95,"endTime":329.25,"body":"We make decisions about"},{"startTime":325.95,"endTime":329.25,"body":"whether to fund based on"},{"startTime":329.25,"endTime":331.74,"body":"clinical effectiveness or"},{"startTime":329.25,"endTime":331.74,"body":"judgements that something"},{"startTime":331.74,"endTime":334.2,"body":"may have a positive clinical impact."},{"startTime":334.2,"endTime":339.0,"body":"The cost effectiveness is looked at,"},{"startTime":339.0,"endTime":344.0,"body":"but unlike the UK for example,"},{"startTime":339.0,"endTime":344.0,"body":"we don't make decisions,"},{"startTime":344.55,"endTime":347.01,"body":"or recommendations, or"},{"startTime":344.55,"endTime":347.01,"body":"change recommendations"},{"startTime":347.01,"endTime":350.58,"body":"based on matters related to"},{"startTime":347.01,"endTime":350.58,"body":"cost or cost effectiveness."},{"startTime":350.58,"endTime":352.35,"body":"The cost effectiveness is simply used"},{"startTime":352.35,"endTime":354.453,"body":"to inform price discussions."},{"startTime":355.56,"endTime":357.063,"body":"- Okay. that makes sense."},{"startTime":358.05,"endTime":360.63,"body":"All right, so we're"},{"startTime":358.05,"endTime":360.63,"body":"going to be talking a bit"},{"startTime":360.63,"endTime":362.91,"body":"about some changes coming up,"},{"startTime":362.91,"endTime":367.11,"body":"but one change that came"},{"startTime":362.91,"endTime":367.11,"body":"into play quite recently,"},{"startTime":367.11,"endTime":371.52,"body":"in September, CADTH introduced"},{"startTime":367.11,"endTime":371.52,"body":"a new type of recommendation,"},{"startTime":371.52,"endTime":375.09,"body":"the time-limited drug"},{"startTime":371.52,"endTime":375.09,"body":"reimbursement recommendations."},{"startTime":375.09,"endTime":377.24,"body":"Perhaps could you tell"},{"startTime":375.09,"endTime":377.24,"body":"us a bit about that?"},{"startTime":379.32,"endTime":380.897,"body":"- You know, the time-limited"},{"startTime":379.32,"endTime":380.897,"body":"drug reimbursement"},{"startTime":380.897,"endTime":383.62,"body":"recommendations was an"},{"startTime":380.897,"endTime":383.62,"body":"attempt to deal with"},{"startTime":384.81,"endTime":387.36,"body":"probably what I think is attention seen"},{"startTime":387.36,"endTime":389.28,"body":"in other jurisdictions as well."},{"startTime":389.28,"endTime":392.58,"body":"A manufacturer has an exciting"},{"startTime":389.28,"endTime":392.58,"body":"and promising new technology."},{"startTime":392.58,"endTime":394.62,"body":"It's exciting and promising"},{"startTime":392.58,"endTime":394.62,"body":"enough that they bring it"},{"startTime":394.62,"endTime":399.62,"body":"to a regulator with early"},{"startTime":394.62,"endTime":399.62,"body":"data, sometimes phase 2 data,"},{"startTime":399.93,"endTime":402.663,"body":"sometimes not comparative phase 2 data."},{"startTime":404.22,"endTime":407.82,"body":"And there's a lot of"},{"startTime":404.22,"endTime":407.82,"body":"uncertainty, sometimes,"},{"startTime":407.82,"endTime":408.9,"body":"with these data."},{"startTime":408.9,"endTime":410.79,"body":"I mean, we could have phase 2 data"},{"startTime":410.79,"endTime":413.04,"body":"with surrogate outcomes, for example."},{"startTime":413.04,"endTime":415.683,"body":"I think what was happening was,"},{"startTime":417.0,"endTime":419.7,"body":"the end result was drugs"},{"startTime":417.0,"endTime":419.7,"body":"were coming to market,"},{"startTime":419.7,"endTime":422.103,"body":"available, could be a"},{"startTime":419.7,"endTime":422.103,"body":"valuable cancer drug,"},{"startTime":422.94,"endTime":427.94,"body":"at least something that"},{"startTime":422.94,"endTime":427.94,"body":"patients were very hopeful"},{"startTime":428.01,"endTime":432.21,"body":"would be valuable, and it was available."},{"startTime":432.21,"endTime":434.32,"body":"But when going through the CADTH process"},{"startTime":435.45,"endTime":436.447,"body":"committees might say,"},{"startTime":436.447,"endTime":440.46,"body":"\"Hmm, it's a phase 2,"},{"startTime":436.447,"endTime":440.46,"body":"we're kind of uncertain."},{"startTime":440.46,"endTime":442.77,"body":"And we do see that the"},{"startTime":440.46,"endTime":442.77,"body":"manufacturers actually plan"},{"startTime":442.77,"endTime":444.903,"body":"a phase 3 trial."},{"startTime":445.74,"endTime":446.79,"body":"What's the rush?"},{"startTime":446.79,"endTime":448.74,"body":"Maybe we should, you know, make sure"},{"startTime":448.74,"endTime":450.66,"body":"that we're making a good"},{"startTime":448.74,"endTime":450.66,"body":"decision because that phase 3"},{"startTime":450.66,"endTime":451.86,"body":"is going to confirm some things"},{"startTime":451.86,"endTime":453.87,"body":"that we're really uncertain about.\""},{"startTime":453.87,"endTime":456.45,"body":"And so they might say \"no\"."},{"startTime":456.45,"endTime":459.51,"body":"Well if you're a patient,"},{"startTime":456.45,"endTime":459.51,"body":"and you are excited"},{"startTime":459.51,"endTime":462.42,"body":"about a new drug that really"},{"startTime":459.51,"endTime":462.42,"body":"might provide benefit for you"},{"startTime":462.42,"endTime":466.14,"body":"and you're told \"No,"},{"startTime":462.42,"endTime":466.14,"body":"this can't be reimbursed"},{"startTime":466.14,"endTime":468.24,"body":"because we're waiting for more certainty,\""},{"startTime":469.17,"endTime":471.03,"body":"that creates certainly a lot of tension."},{"startTime":471.03,"endTime":474.96,"body":"So I think CADTH was responding"},{"startTime":471.03,"endTime":474.96,"body":"to that natural tension"},{"startTime":474.96,"endTime":477.06,"body":"and saying, \"Well, why don't"},{"startTime":474.96,"endTime":477.06,"body":"we build something in here"},{"startTime":477.06,"endTime":479.73,"body":"that says we're going to make something"},{"startTime":479.73,"endTime":481.77,"body":"like a conditional approval."},{"startTime":481.77,"endTime":486.3,"body":"We'll say yes, but we'll"},{"startTime":481.77,"endTime":486.3,"body":"say yes pending further"},{"startTime":486.3,"endTime":489.657,"body":"information, pending a"},{"startTime":486.3,"endTime":489.657,"body":"commitment to a reassessment.\""},{"startTime":490.59,"endTime":494.4,"body":"So I think it was intended"},{"startTime":490.59,"endTime":494.4,"body":"to shore up this gap,"},{"startTime":494.4,"endTime":495.607,"body":"that they were saying \"no\","},{"startTime":495.607,"endTime":498.21,"body":"\"no\" was a pretty blunt"},{"startTime":495.607,"endTime":498.21,"body":"instrument for something"},{"startTime":498.21,"endTime":500.28,"body":"that actually was quite promising."},{"startTime":500.28,"endTime":502.65,"body":"And now they're saying \"yes.\""},{"startTime":502.65,"endTime":505.23,"body":"But it's not a free lunch."},{"startTime":505.23,"endTime":508.83,"body":"It's \"Yes, but we're going to"},{"startTime":505.23,"endTime":508.83,"body":"check your knitting later on."},{"startTime":508.83,"endTime":511.47,"body":"We're going to see if you"},{"startTime":508.83,"endTime":511.47,"body":"actually are living up"},{"startTime":511.47,"endTime":513.717,"body":"to the hype at the time being.\""},{"startTime":515.55,"endTime":519.15,"body":"- Okay, and have there been"},{"startTime":515.55,"endTime":519.15,"body":"any products that have gone"},{"startTime":519.15,"endTime":523.44,"body":"through that process yet, and"},{"startTime":519.15,"endTime":523.44,"body":"have that follow up evaluation"},{"startTime":523.44,"endTime":526.41,"body":"or is it still too early to"},{"startTime":523.44,"endTime":526.41,"body":"see how well it's working?"},{"startTime":526.41,"endTime":528.63,"body":"- No, there have, I don't have"},{"startTime":526.41,"endTime":528.63,"body":"the numbers in front of me,"},{"startTime":528.63,"endTime":531.66,"body":"but it's just begun, I think, in the fall."},{"startTime":531.66,"endTime":535.68,"body":"And now I think we're actually"},{"startTime":531.66,"endTime":535.68,"body":"seeing even the first,"},{"startTime":535.68,"endTime":537.45,"body":"because once CADTH makes a recommendation,"},{"startTime":537.45,"endTime":539.3,"body":"I know we're going to discuss this then,"},{"startTime":540.81,"endTime":542.25,"body":"how do we negotiate the price"},{"startTime":542.25,"endTime":544.71,"body":"of a time-limited recommendation?"},{"startTime":544.71,"endTime":548.19,"body":"Well, we do that through"},{"startTime":544.71,"endTime":548.19,"body":"maybe a special process"},{"startTime":548.19,"endTime":549.15,"body":"of price negotiation."},{"startTime":549.15,"endTime":551.55,"body":"And so my understanding"},{"startTime":549.15,"endTime":551.55,"body":"is we're undergoing"},{"startTime":551.55,"endTime":553.05,"body":"the first one of those."},{"startTime":553.05,"endTime":555.153,"body":"So, I think there have been at least one,"},{"startTime":555.99,"endTime":559.35,"body":"possibly a few, I don't have numbers."},{"startTime":559.35,"endTime":561.72,"body":"The criteria are fairly narrow at present."},{"startTime":561.72,"endTime":565.38,"body":"So, this isn't for anything"},{"startTime":561.72,"endTime":565.38,"body":"that comes along with a phase 2,"},{"startTime":565.38,"endTime":567.75,"body":"it has to have a bunch of conditions."},{"startTime":567.75,"endTime":570.63,"body":"Number one, it has to actually"},{"startTime":567.75,"endTime":570.63,"body":"be given a conditional"},{"startTime":570.63,"endTime":573.27,"body":"approval by the regulator."},{"startTime":573.27,"endTime":575.46,"body":"Like the US we have a"},{"startTime":573.27,"endTime":575.46,"body":"conditional approval."},{"startTime":575.46,"endTime":577.62,"body":"It's called an NOC/c."},{"startTime":577.62,"endTime":581.19,"body":"But there are other things"},{"startTime":577.62,"endTime":581.19,"body":"they have to have, too."},{"startTime":581.19,"endTime":586.14,"body":"For example, they have to"},{"startTime":581.19,"endTime":586.14,"body":"have a phase 3 study ongoing"},{"startTime":586.14,"endTime":589.08,"body":"that they think will confirm"},{"startTime":586.14,"endTime":589.08,"body":"some of the phase 2 stuff."},{"startTime":589.08,"endTime":592.5,"body":"And it actually is also"},{"startTime":589.08,"endTime":592.5,"body":"contingent upon that phase 3 study"},{"startTime":592.5,"endTime":595.38,"body":"results being available"},{"startTime":592.5,"endTime":595.38,"body":"within a few years."},{"startTime":595.38,"endTime":596.49,"body":"I think three."},{"startTime":596.49,"endTime":601.49,"body":"So, it's not every drug that may qualify."},{"startTime":601.62,"endTime":602.97,"body":"It's fairly narrow."},{"startTime":602.97,"endTime":607.97,"body":"I'm sure as they evolve CADTH"},{"startTime":602.97,"endTime":607.97,"body":"is, you know, taking feedback."},{"startTime":608.28,"endTime":611.73,"body":"And I'm sure, as things go,"},{"startTime":608.28,"endTime":611.73,"body":"they may consider expanding this"},{"startTime":611.73,"endTime":613.203,"body":"if this is working out."},{"startTime":614.22,"endTime":617.22,"body":"However, there are some"},{"startTime":614.22,"endTime":617.22,"body":"more strict criteria"},{"startTime":617.22,"endTime":620.763,"body":"around what qualifies for"},{"startTime":617.22,"endTime":620.763,"body":"a time limited-drug review."},{"startTime":622.17,"endTime":623.25,"body":"- Yeah, that makes sense."},{"startTime":623.25,"endTime":626.1,"body":"I think it's areas of"},{"startTime":623.25,"endTime":626.1,"body":"higher unmet need, isn't it?"},{"startTime":626.1,"endTime":629.22,"body":"But yeah, perhaps from"},{"startTime":626.1,"endTime":629.22,"body":"a patient perspective,"},{"startTime":629.22,"endTime":632.79,"body":"and they'll be interested"},{"startTime":629.22,"endTime":632.79,"body":"to see how things work out"},{"startTime":632.79,"endTime":635.79,"body":"and whether that will be"},{"startTime":632.79,"endTime":635.79,"body":"expanded, like you say."},{"startTime":635.79,"endTime":638.43,"body":"So you touched a bit on pricing there."},{"startTime":638.43,"endTime":639.6,"body":"Could you tell us, first of all,"},{"startTime":639.6,"endTime":642.75,"body":"how pharmaceutical pricing"},{"startTime":639.6,"endTime":642.75,"body":"works in Canada overall?"},{"startTime":642.75,"endTime":645.033,"body":"And then we'll come onto some changes."},{"startTime":646.44,"endTime":647.7,"body":"- Yeah, well pricing's tricky business."},{"startTime":647.7,"endTime":650.46,"body":"So we've already said that"},{"startTime":647.7,"endTime":650.46,"body":"there is no universal pharmacare"},{"startTime":650.46,"endTime":653.29,"body":"in Canada, that each"},{"startTime":650.46,"endTime":653.29,"body":"province might have different"},{"startTime":654.21,"endTime":656.61,"body":"public insurance packages,"},{"startTime":654.21,"endTime":656.61,"body":"depending on the province,"},{"startTime":656.61,"endTime":658.74,"body":"depending on what they"},{"startTime":656.61,"endTime":658.74,"body":"perceive are the needs,"},{"startTime":658.74,"endTime":660.153,"body":"and their political goals."},{"startTime":661.65,"endTime":665.34,"body":"But I mean, one thing we need"},{"startTime":661.65,"endTime":665.34,"body":"to be mindful of in Canada"},{"startTime":665.34,"endTime":668.953,"body":"is that public insurance does"},{"startTime":665.34,"endTime":668.953,"body":"not cover anybody, by far."},{"startTime":668.953,"endTime":671.67,"body":"It actually covers a minority of people."},{"startTime":671.67,"endTime":675.36,"body":"There are private insurers,"},{"startTime":671.67,"endTime":675.36,"body":"employee-based private insurance"},{"startTime":675.36,"endTime":678.0,"body":"that covers a similar number of people."},{"startTime":678.0,"endTime":680.01,"body":"And then there are people that simply"},{"startTime":680.01,"endTime":683.16,"body":"have to pay out of pocket."},{"startTime":683.16,"endTime":687.75,"body":"So we have a first level"},{"startTime":683.16,"endTime":687.75,"body":"of price regulation,"},{"startTime":687.75,"endTime":689.58,"body":"which is we actually have"},{"startTime":687.75,"endTime":689.58,"body":"a federal price regulator"},{"startTime":689.58,"endTime":693.57,"body":"that looks to see if list"},{"startTime":689.58,"endTime":693.57,"body":"prices are excessive."},{"startTime":693.57,"endTime":695.58,"body":"And they perform a whole bunch of tests."},{"startTime":695.58,"endTime":698.49,"body":"So they create a kind of ceiling"},{"startTime":695.58,"endTime":698.49,"body":"price for the whole market,"},{"startTime":698.49,"endTime":702.39,"body":"for insurers, and out"},{"startTime":698.49,"endTime":702.39,"body":"of pocket, and the like."},{"startTime":702.39,"endTime":706.59,"body":"And then, probably more"},{"startTime":702.39,"endTime":706.59,"body":"relevant to this conversation,"},{"startTime":706.59,"endTime":711.59,"body":"we have an alliance of price"},{"startTime":706.59,"endTime":711.59,"body":"negotiation across provinces."},{"startTime":713.46,"endTime":715.98,"body":"So we have the Pan-Canadian"},{"startTime":713.46,"endTime":715.98,"body":"Pharmaceutical Alliance."},{"startTime":715.98,"endTime":720.63,"body":"It can take recommendations"},{"startTime":715.98,"endTime":720.63,"body":"from CANAS or CADTH"},{"startTime":720.63,"endTime":723.3,"body":"or both, or either,"},{"startTime":723.3,"endTime":728.07,"body":"and it uses those recommendations"},{"startTime":728.07,"endTime":730.8,"body":"as the basis for price negotiations."},{"startTime":730.8,"endTime":735.27,"body":"So CADTH might say, \"We"},{"startTime":730.8,"endTime":735.27,"body":"recommend you list this drug,"},{"startTime":735.27,"endTime":737.58,"body":"but we think you should list"},{"startTime":735.27,"endTime":737.58,"body":"it in only these patients,"},{"startTime":737.58,"endTime":741.267,"body":"and with a price reduction"},{"startTime":737.58,"endTime":741.267,"body":"of a certain percentage.\""},{"startTime":742.77,"endTime":744.19,"body":"So they will take that"},{"startTime":745.2,"endTime":748.17,"body":"and use that as the basis for negotiation"},{"startTime":748.17,"endTime":751.23,"body":"as a collective negotiation,"},{"startTime":748.17,"endTime":751.23,"body":"so that all provinces"},{"startTime":751.23,"endTime":755.657,"body":"can enjoy the same amount of access,"},{"startTime":757.98,"endTime":759.93,"body":"or access conditions."},{"startTime":759.93,"endTime":763.11,"body":"And that is going on."},{"startTime":763.11,"endTime":767.43,"body":"And the Pan-Canadian"},{"startTime":763.11,"endTime":767.43,"body":"Pharmaceutical Alliance, the PCPA,"},{"startTime":767.43,"endTime":771.183,"body":"is now even, sort of"},{"startTime":767.43,"endTime":771.183,"body":"expanding efforts as we speak."},{"startTime":773.61,"endTime":777.36,"body":"- And you mentioned that the"},{"startTime":773.61,"endTime":777.36,"body":"PCPA had a companion piece"},{"startTime":777.36,"endTime":782.34,"body":"to the conditional reimbursement changes."},{"startTime":782.34,"endTime":785.19,"body":"Could you describe that for us, please?"},{"startTime":785.19,"endTime":788.07,"body":"- Yeah, well they did"},{"startTime":785.19,"endTime":788.07,"body":"have to respond to the,"},{"startTime":788.07,"endTime":793.07,"body":"what do we do when CADTH says,"},{"startTime":793.567,"endTime":796.08,"body":"\"This is a conditional recommendation"},{"startTime":796.08,"endTime":797.997,"body":"pending further information.\""},{"startTime":798.93,"endTime":801.45,"body":"They had no, sort of way"},{"startTime":798.93,"endTime":801.45,"body":"of dealing with that."},{"startTime":801.45,"endTime":802.59,"body":"So they created what they call"},{"startTime":802.59,"endTime":807.0,"body":"the PCPA temporary access process."},{"startTime":807.0,"endTime":810.59,"body":"And that's, for short, PTAP."},{"startTime":810.59,"endTime":813.45,"body":"And so they take a CADTH"},{"startTime":810.59,"endTime":813.45,"body":"time-limited recommendation,"},{"startTime":813.45,"endTime":815.46,"body":"and the idea is that"},{"startTime":813.45,"endTime":815.46,"body":"they would then convert"},{"startTime":815.46,"endTime":819.06,"body":"that into a time-limited negotiation."},{"startTime":819.06,"endTime":822.84,"body":"And you can imagine, it"},{"startTime":819.06,"endTime":822.84,"body":"just form follows function,"},{"startTime":822.84,"endTime":824.1,"body":"or function follows form."},{"startTime":824.1,"endTime":829.1,"body":"It just says, okay, these negotiations"},{"startTime":829.17,"endTime":831.723,"body":"will be subject to a reevaluation."},{"startTime":832.83,"endTime":835.173,"body":"And, you know."},{"startTime":837.69,"endTime":839.483,"body":"So we're going to be"},{"startTime":837.69,"endTime":839.483,"body":"renegotiating the price."},{"startTime":839.483,"endTime":842.52,"body":"Again, people can Google \"PTAP\""},{"startTime":842.52,"endTime":845.163,"body":"and look at all the"},{"startTime":842.52,"endTime":845.163,"body":"criteria that are involved,"},{"startTime":846.39,"endTime":850.53,"body":"but it just is simply a way of"},{"startTime":846.39,"endTime":850.53,"body":"dealing with a recommendation"},{"startTime":850.53,"endTime":852.243,"body":"that is not meant to be permanent."},{"startTime":854.67,"endTime":856.59,"body":"- Okay. All right."},{"startTime":856.59,"endTime":860.52,"body":"So if we could turn our"},{"startTime":856.59,"endTime":860.52,"body":"attention to some future changes."},{"startTime":860.52,"endTime":862.98,"body":"I think there was a"},{"startTime":860.52,"endTime":862.98,"body":"recent consultation led"},{"startTime":862.98,"endTime":866.43,"body":"by the Canadian Drug"},{"startTime":862.98,"endTime":866.43,"body":"Agency Transition Office,"},{"startTime":866.43,"endTime":868.86,"body":"and they were looking at high drug costs,"},{"startTime":868.86,"endTime":870.153,"body":"inaccessible health data"},{"startTime":870.99,"endTime":875.1,"body":"and lack of consistent standards"},{"startTime":870.99,"endTime":875.1,"body":"for prescribing practises."},{"startTime":875.1,"endTime":877.02,"body":"And all that has led to the creation"},{"startTime":877.02,"endTime":879.35,"body":"of the Canadian Drug Agency, the CDA."},{"startTime":879.35,"endTime":881.46,"body":"So I was hoping you"},{"startTime":879.35,"endTime":881.46,"body":"could tell our audience"},{"startTime":881.46,"endTime":882.723,"body":"a bit more about that."},{"startTime":885.21,"endTime":887.7,"body":"- Yeah, well the Canadian"},{"startTime":885.21,"endTime":887.7,"body":"Drug Agency is sort of meant"},{"startTime":887.7,"endTime":889.68,"body":"to tackle a couple of things at once."},{"startTime":889.68,"endTime":894.33,"body":"So I think in the background"},{"startTime":889.68,"endTime":894.33,"body":"there's always been an intent"},{"startTime":894.33,"endTime":896.19,"body":"by the federal government to develop"},{"startTime":896.19,"endTime":900.12,"body":"a kind of universal pharmacare programme."},{"startTime":900.12,"endTime":903.06,"body":"So I started off by saying there"},{"startTime":900.12,"endTime":903.06,"body":"is no universal pharmacare,"},{"startTime":903.06,"endTime":908.06,"body":"but some people see this"},{"startTime":903.06,"endTime":908.06,"body":"as a real shortsightedness"},{"startTime":908.64,"endTime":910.98,"body":"that this was never put into place."},{"startTime":910.98,"endTime":915.63,"body":"So our current federal"},{"startTime":910.98,"endTime":915.63,"body":"government has put on the table"},{"startTime":915.63,"endTime":918.58,"body":"that this is something that"},{"startTime":915.63,"endTime":918.58,"body":"they would like to put forward."},{"startTime":920.25,"endTime":924.0,"body":"In doing so, they sort"},{"startTime":920.25,"endTime":924.0,"body":"of gave some thought to,"},{"startTime":924.0,"endTime":928.47,"body":"okay, if we really were to"},{"startTime":924.0,"endTime":928.47,"body":"do a universal pharmacare,"},{"startTime":928.47,"endTime":931.53,"body":"what are some things that"},{"startTime":928.47,"endTime":931.53,"body":"would need to be in place"},{"startTime":931.53,"endTime":933.69,"body":"to make it sort of optimal?"},{"startTime":933.69,"endTime":938.64,"body":"And one of those things was"},{"startTime":933.69,"endTime":938.64,"body":"having a Canadian Drug Agency,"},{"startTime":938.64,"endTime":943.64,"body":"having a body that could"},{"startTime":938.64,"endTime":943.64,"body":"inform this federal"},{"startTime":944.31,"endTime":948.12,"body":"pharmacare programme about"},{"startTime":944.31,"endTime":948.12,"body":"what drugs should be paid for,"},{"startTime":948.12,"endTime":951.69,"body":"and at what price, and under"},{"startTime":948.12,"endTime":951.69,"body":"what conditions, and the like."},{"startTime":951.69,"endTime":953.76,"body":"Now, CADTH was already"},{"startTime":951.69,"endTime":953.76,"body":"doing this kind of work."},{"startTime":953.76,"endTime":958.02,"body":"So I think what the federal"},{"startTime":953.76,"endTime":958.02,"body":"government's response was,"},{"startTime":958.02,"endTime":959.689,"body":"was they created what they called"},{"startTime":959.689,"endTime":962.73,"body":"a Canadian Drug Agency Transition Office,"},{"startTime":962.73,"endTime":965.7,"body":"and essentially came out"},{"startTime":962.73,"endTime":965.7,"body":"with a recommendation"},{"startTime":965.7,"endTime":968.16,"body":"that we're going to build"},{"startTime":965.7,"endTime":968.16,"body":"a Canadian Drug Agency,"},{"startTime":968.16,"endTime":969.48,"body":"but essentially we're"},{"startTime":968.16,"endTime":969.48,"body":"just going to build it"},{"startTime":969.48,"endTime":971.013,"body":"in and around CADTH."},{"startTime":971.91,"endTime":974.94,"body":"You know, in other words,"},{"startTime":971.91,"endTime":974.94,"body":"CADTH's core function is fine."},{"startTime":974.94,"endTime":976.473,"body":"That's exactly the kind"},{"startTime":974.94,"endTime":976.473,"body":"of thing we want to do."},{"startTime":976.473,"endTime":979.093,"body":"But there might be some other pieces that"},{"startTime":979.093,"endTime":980.34,"body":"we want to throw in."},{"startTime":980.34,"endTime":984.882,"body":"So for example, the federal government"},{"startTime":984.882,"endTime":986.94,"body":"also funds research,"},{"startTime":986.94,"endTime":990.47,"body":"and they fund research that"},{"startTime":986.94,"endTime":990.47,"body":"can be particularly valuable"},{"startTime":990.47,"endTime":995.47,"body":"in looking at things like"},{"startTime":990.47,"endTime":995.47,"body":"post-marketing drug evaluation."},{"startTime":996.15,"endTime":999.45,"body":"CADTH also now does some level"},{"startTime":999.45,"endTime":1000.89,"body":"of post-marketing drug evaluation."},{"startTime":1000.89,"endTime":1002.93,"body":"So, one of the things they thought,"},{"startTime":1002.93,"endTime":1005.0,"body":"well, we should potentially bolster that."},{"startTime":1005.0,"endTime":1009.5,"body":"And we could bolster other"},{"startTime":1005.0,"endTime":1009.5,"body":"things that we do in this space"},{"startTime":1009.5,"endTime":1012.42,"body":"to improve the amount"},{"startTime":1009.5,"endTime":1012.42,"body":"of information and data"},{"startTime":1013.28,"endTime":1016.043,"body":"used to inform drug decisions."},{"startTime":1017.21,"endTime":1020.63,"body":"And along with that is a"},{"startTime":1017.21,"endTime":1020.63,"body":"thought that we should also"},{"startTime":1020.63,"endTime":1022.67,"body":"probably shore up and improve the way"},{"startTime":1022.67,"endTime":1023.87,"body":"that we fund rare drugs."},{"startTime":1023.87,"endTime":1027.86,"body":"And so an additional activity,"},{"startTime":1027.86,"endTime":1029.57,"body":"and maybe I'm sure we'll"},{"startTime":1027.86,"endTime":1029.57,"body":"be talking about it,"},{"startTime":1029.57,"endTime":1033.83,"body":"is also looking at what"},{"startTime":1029.57,"endTime":1033.83,"body":"should be our strategy"},{"startTime":1033.83,"endTime":1035.9,"body":"for addressing rare disease."},{"startTime":1035.9,"endTime":1038.36,"body":"And so all of this is sort of culminated."},{"startTime":1038.36,"endTime":1043.36,"body":"But the Canadian Drug Agency"},{"startTime":1038.36,"endTime":1043.36,"body":"as a starting point is intended"},{"startTime":1043.7,"endTime":1048.5,"body":"to be a kind of CADTH-like"},{"startTime":1043.7,"endTime":1048.5,"body":"body that's going to ultimately"},{"startTime":1048.5,"endTime":1052.343,"body":"inform a federal pharmacare programme."},{"startTime":1053.774,"endTime":1056.27,"body":"- Okay, that makes sense."},{"startTime":1056.27,"endTime":1058.97,"body":"So I know, not these changes, perhaps,"},{"startTime":1058.97,"endTime":1061.13,"body":"haven't really come into effect yet,"},{"startTime":1061.13,"endTime":1063.83,"body":"and as you said it, it"},{"startTime":1061.13,"endTime":1063.83,"body":"might all still be up"},{"startTime":1063.83,"endTime":1067.97,"body":"for some further change, but"},{"startTime":1063.83,"endTime":1067.97,"body":"based on what we know so far,"},{"startTime":1067.97,"endTime":1071.96,"body":"what do these proposed mean"},{"startTime":1067.97,"endTime":1071.96,"body":"for pharmaceutical companies?"},{"startTime":1071.96,"endTime":1073.43,"body":"Do you think there will be anything"},{"startTime":1073.43,"endTime":1075.38,"body":"they'll need to do differently,"},{"startTime":1075.38,"endTime":1078.41,"body":"or any change to their strategies"},{"startTime":1078.41,"endTime":1080.633,"body":"compared with the the current strategy?"},{"startTime":1082.19,"endTime":1086.48,"body":"- Yeah, and I'm sure they're"},{"startTime":1082.19,"endTime":1086.48,"body":"dying to know. (laughing)"},{"startTime":1086.48,"endTime":1087.92,"body":"Do we need to change anything?"},{"startTime":1087.92,"endTime":1090.293,"body":"And the short answer is no."},{"startTime":1092.33,"endTime":1095.09,"body":"You know, I did say, I think"},{"startTime":1092.33,"endTime":1095.09,"body":"the commitment has been made"},{"startTime":1095.09,"endTime":1097.31,"body":"that they're going to build something"},{"startTime":1097.31,"endTime":1102.31,"body":"upon the existing mandate"},{"startTime":1097.31,"endTime":1102.31,"body":"and functions of CADTH."},{"startTime":1104.24,"endTime":1106.82,"body":"They're not intending to replace it"},{"startTime":1106.82,"endTime":1108.92,"body":"with something different."},{"startTime":1108.92,"endTime":1111.44,"body":"So, you know, I think"},{"startTime":1108.92,"endTime":1111.44,"body":"if you're a drug company"},{"startTime":1111.44,"endTime":1115.37,"body":"and you're thinking \"I need"},{"startTime":1111.44,"endTime":1115.37,"body":"to get past the CADTH post,\""},{"startTime":1115.37,"endTime":1117.983,"body":"well nothing's going to"},{"startTime":1115.37,"endTime":1117.983,"body":"change in the short term."},{"startTime":1119.21,"endTime":1120.71,"body":"That is for innovative drug companies."},{"startTime":1120.71,"endTime":1122.75,"body":"Obviously generic drug companies,"},{"startTime":1122.75,"endTime":1124.88,"body":"there might be things afoot."},{"startTime":1124.88,"endTime":1129.88,"body":"But, so that's one aspect of this."},{"startTime":1130.94,"endTime":1133.67,"body":"I think what you need to think"},{"startTime":1130.94,"endTime":1133.67,"body":"is, you need to look at CADTH"},{"startTime":1133.67,"endTime":1135.47,"body":"currently and its functions,"},{"startTime":1135.47,"endTime":1137.03,"body":"for example reimbursement review"},{"startTime":1137.03,"endTime":1139.25,"body":"and the post-marketing drug evaluation,"},{"startTime":1139.25,"endTime":1142.16,"body":"and just think it's going to"},{"startTime":1139.25,"endTime":1142.16,"body":"be a bolstered version of that."},{"startTime":1142.16,"endTime":1144.53,"body":"It's going to be a more"},{"startTime":1142.16,"endTime":1144.53,"body":"robust version of that"},{"startTime":1144.53,"endTime":1149.53,"body":"with sort of more data"},{"startTime":1144.53,"endTime":1149.53,"body":"outreach and you know,"},{"startTime":1151.67,"endTime":1153.98,"body":"more of a focus on rare and the like."},{"startTime":1153.98,"endTime":1157.43,"body":"So I think that's what you"},{"startTime":1153.98,"endTime":1157.43,"body":"should be thinking about."},{"startTime":1157.43,"endTime":1160.58,"body":"But really no changes,"},{"startTime":1157.43,"endTime":1160.58,"body":"no announced changes."},{"startTime":1160.58,"endTime":1162.62,"body":"I think in the next couple of months"},{"startTime":1162.62,"endTime":1165.08,"body":"we're going to get more information"},{"startTime":1165.08,"endTime":1170.08,"body":"from the Canadian Drug"},{"startTime":1165.08,"endTime":1170.08,"body":"Agency Transition Office,"},{"startTime":1170.18,"endTime":1172.7,"body":"or with the federal government"},{"startTime":1172.7,"endTime":1175.19,"body":"about what further change could look like."},{"startTime":1175.19,"endTime":1178.91,"body":"But again, I wouldn't be changing the way"},{"startTime":1178.91,"endTime":1181.1,"body":"you're doing dossiers currently, I think."},{"startTime":1181.1,"endTime":1183.23,"body":"There are other changes afoot."},{"startTime":1183.23,"endTime":1185.87,"body":"CADTH is looking..."},{"startTime":1185.87,"endTime":1189.03,"body":"CADTH has an what's called"},{"startTime":1185.87,"endTime":1189.03,"body":"an aligned review process"},{"startTime":1190.849,"endTime":1193.493,"body":"with Health Canada, our federal regulator."},{"startTime":1194.57,"endTime":1197.66,"body":"In doing that, they do"},{"startTime":1194.57,"endTime":1197.66,"body":"offer drug companies"},{"startTime":1197.66,"endTime":1201.35,"body":"and opportunity to submit applications"},{"startTime":1201.35,"endTime":1204.653,"body":"to CADTH six months"},{"startTime":1201.35,"endTime":1204.653,"body":"prior to getting an NOC."},{"startTime":1206.3,"endTime":1209.39,"body":"That programme has been"},{"startTime":1206.3,"endTime":1209.39,"body":"in place for a while,"},{"startTime":1209.39,"endTime":1212.99,"body":"but it does not enjoy 100% uptake."},{"startTime":1212.99,"endTime":1217.28,"body":"And CADTH now is looking"},{"startTime":1212.99,"endTime":1217.28,"body":"at, and looking at reasons"},{"startTime":1217.28,"endTime":1221.63,"body":"as to why or how they can"},{"startTime":1217.28,"endTime":1221.63,"body":"improve the uptake of that"},{"startTime":1221.63,"endTime":1225.62,"body":"so that CADTH"},{"startTime":1221.63,"endTime":1225.62,"body":"recommendations can be issued"},{"startTime":1225.62,"endTime":1228.473,"body":"at the time of a regulatory decision."},{"startTime":1229.792,"endTime":1231.74,"body":"And their goal is, wouldn't that be great"},{"startTime":1231.74,"endTime":1234.17,"body":"if it occurred all the time?"},{"startTime":1234.17,"endTime":1236.97,"body":"So, you know, I think one"},{"startTime":1234.17,"endTime":1236.97,"body":"thing companies can do now"},{"startTime":1237.98,"endTime":1242.91,"body":"is get involved with CADTH's"},{"startTime":1237.98,"endTime":1242.91,"body":"Target Zero initiative"},{"startTime":1244.1,"endTime":1249.1,"body":"and look, or just investigate,"},{"startTime":1244.1,"endTime":1249.1,"body":"see how they can improve"},{"startTime":1249.56,"endTime":1252.77,"body":"their own internal processes to get in"},{"startTime":1252.77,"endTime":1256.49,"body":"their applications six"},{"startTime":1252.77,"endTime":1256.49,"body":"months before an NOC,"},{"startTime":1256.49,"endTime":1258.623,"body":"rather than after the fact."},{"startTime":1261.277,"endTime":1264.673,"body":"- That's great observation,"},{"startTime":1261.277,"endTime":1264.673,"body":"great advice I think."},{"startTime":1266.21,"endTime":1269.63,"body":"Yeah, I'm sure our audience"},{"startTime":1266.21,"endTime":1269.63,"body":"will appreciate that."},{"startTime":1269.63,"endTime":1273.7,"body":"You touched on there perhaps"},{"startTime":1269.63,"endTime":1273.7,"body":"some changes with the advent"},{"startTime":1273.7,"endTime":1278.7,"body":"of CDA that might impact things"},{"startTime":1273.7,"endTime":1278.7,"body":"like post-launch strategy."},{"startTime":1279.11,"endTime":1281.66,"body":"You've mentioned maybe"},{"startTime":1279.11,"endTime":1281.66,"body":"more data requirements."},{"startTime":1281.66,"endTime":1284.12,"body":"Would you care to speculate on anything"},{"startTime":1284.12,"endTime":1285.57,"body":"that might be required there?"},{"startTime":1288.17,"endTime":1290.84,"body":"- No, I think, you know,"},{"startTime":1288.17,"endTime":1290.84,"body":"CADTH currently is actually,"},{"startTime":1290.84,"endTime":1293.6,"body":"through their post-marketing"},{"startTime":1290.84,"endTime":1293.6,"body":"drug evaluation programme,"},{"startTime":1293.6,"endTime":1297.83,"body":"already looking at sort of"},{"startTime":1293.6,"endTime":1297.83,"body":"answering relevant questions"},{"startTime":1297.83,"endTime":1301.25,"body":"for policymakers using what available"},{"startTime":1301.25,"endTime":1304.25,"body":"real-world data there are."},{"startTime":1304.25,"endTime":1306.137,"body":"They are currently"},{"startTime":1304.25,"endTime":1306.137,"body":"looking at expanding that,"},{"startTime":1306.137,"endTime":1309.14,"body":"and actually I believe"},{"startTime":1306.137,"endTime":1309.14,"body":"they've already started"},{"startTime":1309.14,"endTime":1313.76,"body":"expanding that to not only"},{"startTime":1309.14,"endTime":1313.76,"body":"working with academic partners"},{"startTime":1313.76,"endTime":1318.5,"body":"who have access to"},{"startTime":1313.76,"endTime":1318.5,"body":"valuable healthcare data,"},{"startTime":1318.5,"endTime":1323.21,"body":"but also industry partners to, you know,"},{"startTime":1323.21,"endTime":1325.82,"body":"because often industry"},{"startTime":1323.21,"endTime":1325.82,"body":"partners have access"},{"startTime":1325.82,"endTime":1330.743,"body":"to real-world data that is"},{"startTime":1325.82,"endTime":1330.743,"body":"not otherwise well known."},{"startTime":1331.64,"endTime":1334.013,"body":"So, they've begun that work."},{"startTime":1337.772,"endTime":1340.67,"body":"And they've also now creating"},{"startTime":1337.772,"endTime":1340.67,"body":"an inventory of registries,"},{"startTime":1340.67,"endTime":1343.43,"body":"they want to bolster activity"},{"startTime":1340.67,"endTime":1343.43,"body":"in the use of registries."},{"startTime":1343.43,"endTime":1347.18,"body":"I think CADTH sees"},{"startTime":1343.43,"endTime":1347.18,"body":"registries as providing,"},{"startTime":1347.18,"endTime":1351.98,"body":"potentially, valuable and"},{"startTime":1347.18,"endTime":1351.98,"body":"reliable data for decisions"},{"startTime":1351.98,"endTime":1354.203,"body":"and evaluations related"},{"startTime":1351.98,"endTime":1354.203,"body":"to real-world data."},{"startTime":1355.46,"endTime":1360.46,"body":"So, does this change what"},{"startTime":1355.46,"endTime":1360.46,"body":"a company is doing now?"},{"startTime":1361.52,"endTime":1364.1,"body":"Not really, but it does mean"},{"startTime":1361.52,"endTime":1364.1,"body":"that they could potentially"},{"startTime":1364.1,"endTime":1368.99,"body":"be more involved, or that"},{"startTime":1364.1,"endTime":1368.99,"body":"there are opportunities"},{"startTime":1368.99,"endTime":1373.99,"body":"now to share post-marketing"},{"startTime":1368.99,"endTime":1373.99,"body":"data with CADTH"},{"startTime":1375.59,"endTime":1380.59,"body":"to help CADTH answer important"},{"startTime":1375.59,"endTime":1380.59,"body":"questions for policymakers."},{"startTime":1382.67,"endTime":1387.197,"body":"So, I mean the general"},{"startTime":1382.67,"endTime":1387.197,"body":"gestalten of CADTH currently"},{"startTime":1389.24,"endTime":1392.51,"body":"is that they opened up a little more."},{"startTime":1392.51,"endTime":1396.8,"body":"I think it's easier for"},{"startTime":1392.51,"endTime":1396.8,"body":"stakeholders to exchange with CADTH,"},{"startTime":1396.8,"endTime":1399.26,"body":"and I think it's easier"},{"startTime":1396.8,"endTime":1399.26,"body":"for industry, frankly,"},{"startTime":1399.26,"endTime":1401.03,"body":"to exchange with CADTH."},{"startTime":1401.03,"endTime":1404.87,"body":"So maybe one other thing"},{"startTime":1401.03,"endTime":1404.87,"body":"people should be mindful of is,"},{"startTime":1404.87,"endTime":1406.85,"body":"particularly in the last year,"},{"startTime":1406.85,"endTime":1410.003,"body":"and with the new leadership"},{"startTime":1406.85,"endTime":1410.003,"body":"of Suzanne McGurn,"},{"startTime":1411.08,"endTime":1414.26,"body":"we've seen more of an openness."},{"startTime":1414.26,"endTime":1416.18,"body":"So I think one of the things that industry"},{"startTime":1416.18,"endTime":1419.337,"body":"should be mindful of is if"},{"startTime":1416.18,"endTime":1419.337,"body":"they have in their heads that,"},{"startTime":1419.337,"endTime":1422.343,"body":"you know, it's very difficult"},{"startTime":1419.337,"endTime":1422.343,"body":"to interact with CADTH,"},{"startTime":1422.343,"endTime":1427.343,"body":"I think that assumption"},{"startTime":1422.343,"endTime":1427.343,"body":"might need to be discarded."},{"startTime":1429.23,"endTime":1432.62,"body":"I think it's a lot easier now to interact."},{"startTime":1432.62,"endTime":1434.51,"body":"CADTH has expanded the"},{"startTime":1432.62,"endTime":1434.51,"body":"time that they commit"},{"startTime":1434.51,"endTime":1436.28,"body":"to pre-submission meetings,"},{"startTime":1436.28,"endTime":1438.05,"body":"and there are other opportunities."},{"startTime":1438.05,"endTime":1441.56,"body":"So yeah, I think people"},{"startTime":1438.05,"endTime":1441.56,"body":"should be seeing CADTH as more"},{"startTime":1441.56,"endTime":1445.01,"body":"of an opportunity than a"},{"startTime":1441.56,"endTime":1445.01,"body":"barrier, as it might have been"},{"startTime":1445.01,"endTime":1447.413,"body":"back in the days of older leadership."},{"startTime":1449.09,"endTime":1449.923,"body":"- That's great."},{"startTime":1449.923,"endTime":1451.34,"body":"That sounds like a really positive thing."},{"startTime":1451.34,"endTime":1454.37,"body":"And yeah, I think the more"},{"startTime":1451.34,"endTime":1454.37,"body":"pharma companies can engage"},{"startTime":1454.37,"endTime":1457.13,"body":"with these decision making"},{"startTime":1454.37,"endTime":1457.13,"body":"bodies, reimbursement bodies,"},{"startTime":1457.13,"endTime":1459.95,"body":"and HTA then, you know, we're all trying"},{"startTime":1459.95,"endTime":1461.69,"body":"to do the same thing"},{"startTime":1459.95,"endTime":1461.69,"body":"ultimately, aren't we?"},{"startTime":1461.69,"endTime":1463.853,"body":"So that's great advice."},{"startTime":1464.81,"endTime":1468.65,"body":"I'd just like to think a bit"},{"startTime":1464.81,"endTime":1468.65,"body":"more broadly now, for a moment."},{"startTime":1468.65,"endTime":1471.95,"body":"So you'll be aware of the"},{"startTime":1468.65,"endTime":1471.95,"body":"joint clinical assessment"},{"startTime":1471.95,"endTime":1474.65,"body":"coming in in Europe over the coming years."},{"startTime":1474.65,"endTime":1478.61,"body":"Just wondered how that might"},{"startTime":1474.65,"endTime":1478.61,"body":"impact things in Canada,"},{"startTime":1478.61,"endTime":1481.01,"body":"and in other countries, maybe."},{"startTime":1481.01,"endTime":1485.42,"body":"Whether the HCA bodies, for example CADTH,"},{"startTime":1485.42,"endTime":1487.49,"body":"might look at what's going on there"},{"startTime":1487.49,"endTime":1491.03,"body":"and perhaps even take note of"},{"startTime":1487.49,"endTime":1491.03,"body":"the reports being published"},{"startTime":1491.03,"endTime":1494.72,"body":"by JCA to see if that has any bearing"},{"startTime":1494.72,"endTime":1496.973,"body":"on decisions in Canada."},{"startTime":1499.31,"endTime":1500.143,"body":"- Well, it may do."},{"startTime":1500.143,"endTime":1503.57,"body":"We have to also be mindful"},{"startTime":1500.143,"endTime":1503.57,"body":"that in August of last year,"},{"startTime":1503.57,"endTime":1507.68,"body":"CADTH and some other"},{"startTime":1503.57,"endTime":1507.68,"body":"agencies did get together"},{"startTime":1507.68,"endTime":1511.82,"body":"and say, \"Hey, maybe it's a good idea"},{"startTime":1511.82,"endTime":1514.07,"body":"that we start to do things together."},{"startTime":1514.07,"endTime":1516.23,"body":"We start to share work."},{"startTime":1516.23,"endTime":1520.85,"body":"We start to have our horizon"},{"startTime":1516.23,"endTime":1520.85,"body":"scanning processes aligning.\""},{"startTime":1520.85,"endTime":1523.55,"body":"We look at collective methods."},{"startTime":1523.55,"endTime":1525.44,"body":"How do we all look at surrogate outcomes?"},{"startTime":1525.44,"endTime":1528.14,"body":"Originally this was just a smaller group"},{"startTime":1528.14,"endTime":1531.47,"body":"of HTA organisations internationally."},{"startTime":1531.47,"endTime":1536.47,"body":"I think it was NICE, ICER,"},{"startTime":1531.47,"endTime":1536.47,"body":"CADTH, but that's expanded."},{"startTime":1538.13,"endTime":1542.06,"body":"There's a larger group now,"},{"startTime":1538.13,"endTime":1542.06,"body":"including a lot of the groups"},{"startTime":1542.06,"endTime":1545.42,"body":"in the UK, the Australian government."},{"startTime":1545.42,"endTime":1550.42,"body":"So yes, while I'm aware there's"},{"startTime":1545.42,"endTime":1550.42,"body":"joint clinical assessment"},{"startTime":1550.73,"endTime":1554.54,"body":"going on in the European context,"},{"startTime":1554.54,"endTime":1556.787,"body":"there is also more international"},{"startTime":1554.54,"endTime":1556.787,"body":"collaboration going on."},{"startTime":1556.787,"endTime":1560.843,"body":"And in part, sort of"},{"startTime":1556.787,"endTime":1560.843,"body":"catalysed by CADTH and others."},{"startTime":1562.82,"endTime":1564.83,"body":"I think it's just a logical response."},{"startTime":1564.83,"endTime":1569.0,"body":"How do you respond to a multinational"},{"startTime":1569.0,"endTime":1570.71,"body":"pharmaceutical company?"},{"startTime":1570.71,"endTime":1572.96,"body":"Well, you respond through international"},{"startTime":1572.96,"endTime":1574.34,"body":"collaborations, right?"},{"startTime":1574.34,"endTime":1577.04,"body":"Let's have, you know, we have..."},{"startTime":1577.04,"endTime":1582.02,"body":"We have somebody who would"},{"startTime":1577.04,"endTime":1582.02,"body":"like to get things to patients,"},{"startTime":1582.02,"endTime":1584.77,"body":"but we're mindful of the fact"},{"startTime":1582.02,"endTime":1584.77,"body":"that we need to evaluate."},{"startTime":1585.81,"endTime":1587.33,"body":"Why don't we evaluate collectively?"},{"startTime":1587.33,"endTime":1589.76,"body":"So, I think that's also what's going on."},{"startTime":1589.76,"endTime":1591.5,"body":"So yeah, all the collective stuff"},{"startTime":1591.5,"endTime":1593.95,"body":"that's happening in Europe"},{"startTime":1591.5,"endTime":1593.95,"body":"I think is also being,"},{"startTime":1594.984,"endTime":1597.71,"body":"you see reflectively, it's also happening"},{"startTime":1597.71,"endTime":1600.68,"body":"in the rest of the world now"},{"startTime":1597.71,"endTime":1600.68,"body":"with the HTA organisations."},{"startTime":1600.68,"endTime":1602.57,"body":"And there's more to come."},{"startTime":1602.57,"endTime":1604.01,"body":"We're also seeing it"},{"startTime":1602.57,"endTime":1604.01,"body":"on the regulator side,"},{"startTime":1604.01,"endTime":1605.42,"body":"with things like Project Orbis,"},{"startTime":1605.42,"endTime":1607.43,"body":"where regulators are now getting together"},{"startTime":1607.43,"endTime":1609.86,"body":"and saying, let's just"},{"startTime":1607.43,"endTime":1609.86,"body":"do all of this together,"},{"startTime":1609.86,"endTime":1611.61,"body":"because why are we all duplicating?"},{"startTime":1613.49,"endTime":1615.98,"body":"- Yeah, interesting times."},{"startTime":1615.98,"endTime":1618.117,"body":"Okay, so coming back to the CDA,"},{"startTime":1619.813,"endTime":1622.463,"body":"I think one of the things that the CDA,"},{"startTime":1622.463,"endTime":1626.69,"body":"is expected to impact is"},{"startTime":1622.463,"endTime":1626.69,"body":"the regulatory landscape."},{"startTime":1626.69,"endTime":1629.69,"body":"Have you got any information"},{"startTime":1626.69,"endTime":1629.69,"body":"you can share with us"},{"startTime":1629.69,"endTime":1631.463,"body":"on how that might look?"},{"startTime":1634.61,"endTime":1636.44,"body":"- I don't. (laughing)"},{"startTime":1636.44,"endTime":1641.21,"body":"Again, there's not a lot of information"},{"startTime":1641.21,"endTime":1644.585,"body":"in relation to, you know, what"},{"startTime":1641.21,"endTime":1644.585,"body":"the CDA is going to impact."},{"startTime":1644.585,"endTime":1648.677,"body":"I mean, right now I think the"},{"startTime":1644.585,"endTime":1648.677,"body":"biggest impact is, you know,"},{"startTime":1648.677,"endTime":1650.813,"body":"the CDA is engaged."},{"startTime":1652.07,"endTime":1654.83,"body":"What this has resulted in is there are"},{"startTime":1654.83,"endTime":1656.957,"body":"bilateral negotiations"},{"startTime":1654.83,"endTime":1656.957,"body":"between the federal government"},{"startTime":1656.957,"endTime":1660.23,"body":"and the provinces to discuss, you know,"},{"startTime":1660.23,"endTime":1665.23,"body":"what drugs should we be"},{"startTime":1660.23,"endTime":1665.23,"body":"thinking about in terms of CDA"},{"startTime":1665.371,"endTime":1667.767,"body":"and a federal pharmacare programme."},{"startTime":1667.767,"endTime":1670.858,"body":"And so whereas the"},{"startTime":1667.767,"endTime":1670.858,"body":"pharmacare programme now has"},{"startTime":1670.858,"endTime":1672.47,"body":"been proposed"},{"startTime":1672.47,"endTime":1675.92,"body":"with two classes of"},{"startTime":1672.47,"endTime":1675.92,"body":"drugs, oral contraceptives"},{"startTime":1675.92,"endTime":1678.71,"body":"and diabetes drugs."},{"startTime":1678.71,"endTime":1683.3,"body":"That list is planning to"},{"startTime":1678.71,"endTime":1683.3,"body":"expand, both with input"},{"startTime":1683.3,"endTime":1685.46,"body":"from work that's been"},{"startTime":1683.3,"endTime":1685.46,"body":"done by CADTH and others,"},{"startTime":1685.46,"endTime":1690.083,"body":"but also ultimately through a"},{"startTime":1685.46,"endTime":1690.083,"body":"discussion just about money."},{"startTime":1691.19,"endTime":1694.31,"body":"The way our healthcare system"},{"startTime":1691.19,"endTime":1694.31,"body":"works is there are transfers"},{"startTime":1694.31,"endTime":1697.34,"body":"of payments from the federal"},{"startTime":1694.31,"endTime":1697.34,"body":"government to the provinces,"},{"startTime":1697.34,"endTime":1701.36,"body":"but those transfers sometimes"},{"startTime":1697.34,"endTime":1701.36,"body":"have conditions attached."},{"startTime":1701.36,"endTime":1703.28,"body":"And they certainly always"},{"startTime":1701.36,"endTime":1703.28,"body":"have the conditions related"},{"startTime":1703.28,"endTime":1706.34,"body":"to our Canada Health Act,"},{"startTime":1703.28,"endTime":1706.34,"body":"which is the guiding principles"},{"startTime":1706.34,"endTime":1708.59,"body":"that I mentioned at the"},{"startTime":1706.34,"endTime":1708.59,"body":"beginning that kind of create"},{"startTime":1708.59,"endTime":1712.91,"body":"a more homogeneous delivery of healthcare"},{"startTime":1712.91,"endTime":1715.19,"body":"across the country."},{"startTime":1715.19,"endTime":1719.33,"body":"And so they're using"},{"startTime":1715.19,"endTime":1719.33,"body":"those same conversations"},{"startTime":1719.33,"endTime":1723.54,"body":"around transfers to talk"},{"startTime":1719.33,"endTime":1723.54,"body":"about, okay, what drugs"},{"startTime":1725.12,"endTime":1727.85,"body":"do we think are most valuable to shore up"},{"startTime":1727.85,"endTime":1729.79,"body":"in regards to pharmacare?"},{"startTime":1730.7,"endTime":1732.02,"body":"So, sorry, I'm not sure if that answered"},{"startTime":1732.02,"endTime":1733.463,"body":"the question exactly, but-"},{"startTime":1735.11,"endTime":1736.43,"body":"- It's evolving, isn't it?"},{"startTime":1736.43,"endTime":1739.458,"body":"So I think it is just a case of seeing."},{"startTime":1739.458,"endTime":1740.291,"body":"- It's evolving, yes."},{"startTime":1740.291,"endTime":1742.79,"body":"And like, I'm not aware"},{"startTime":1740.291,"endTime":1742.79,"body":"of any announcements"},{"startTime":1742.79,"endTime":1744.29,"body":"of the regulators saying"},{"startTime":1742.79,"endTime":1744.29,"body":"that they're going to change"},{"startTime":1744.29,"endTime":1745.763,"body":"anything anytime soon."},{"startTime":1746.9,"endTime":1749.66,"body":"So, it doesn't seem..."},{"startTime":1749.66,"endTime":1752.84,"body":"Regulators don't usually change things."},{"startTime":1752.84,"endTime":1754.43,"body":"Nothing happens too quickly."},{"startTime":1754.43,"endTime":1757.34,"body":"So nobody has to worry that"},{"startTime":1754.43,"endTime":1757.34,"body":"they're going to have a nap"},{"startTime":1757.34,"endTime":1758.78,"body":"and things are going to change."},{"startTime":1758.78,"endTime":1760.853,"body":"It's the glacial pace of policymaking."},{"startTime":1762.23,"endTime":1763.94,"body":"- Yeah, sometimes these"},{"startTime":1762.23,"endTime":1763.94,"body":"announcements happen"},{"startTime":1763.94,"endTime":1765.44,"body":"and you think, \"Oh god, it's all changing."},{"startTime":1765.44,"endTime":1766.85,"body":"We must do something immediately.\""},{"startTime":1766.85,"endTime":1769.79,"body":"But the fact is it takes time."},{"startTime":1769.79,"endTime":1772.22,"body":"- No, and often the"},{"startTime":1769.79,"endTime":1772.22,"body":"announcements relate to,"},{"startTime":1772.22,"endTime":1774.44,"body":"we're announcing that"},{"startTime":1772.22,"endTime":1774.44,"body":"we need to plan a plan."},{"startTime":1774.44,"endTime":1775.72,"body":"So, you know, it's..."},{"startTime":1776.78,"endTime":1778.52,"body":"I think you know, what"},{"startTime":1776.78,"endTime":1778.52,"body":"it does mean, though,"},{"startTime":1778.52,"endTime":1780.41,"body":"is obviously industry stakeholders,"},{"startTime":1780.41,"endTime":1782.66,"body":"or academic stakeholders, or the like,"},{"startTime":1782.66,"endTime":1784.82,"body":"they should be looking to"},{"startTime":1782.66,"endTime":1784.82,"body":"see how they can be involved."},{"startTime":1784.82,"endTime":1786.86,"body":"Because one of the"},{"startTime":1784.82,"endTime":1786.86,"body":"things that is happening"},{"startTime":1786.86,"endTime":1790.078,"body":"in and around pharmacare,"},{"startTime":1786.86,"endTime":1790.078,"body":"and CDA, and the like,"},{"startTime":1790.078,"endTime":1793.79,"body":"is there's more consultation,"},{"startTime":1793.79,"endTime":1797.66,"body":"more exchange, more"},{"startTime":1793.79,"endTime":1797.66,"body":"opportunities for input"},{"startTime":1797.66,"endTime":1800.33,"body":"going on in and around this."},{"startTime":1800.33,"endTime":1803.87,"body":"So, people very interested"},{"startTime":1800.33,"endTime":1803.87,"body":"should be looking"},{"startTime":1803.87,"endTime":1805.103,"body":"for those opportunities."},{"startTime":1806.78,"endTime":1808.76,"body":"- That's great, thank you."},{"startTime":1808.76,"endTime":1810.59,"body":"All right, so I'd like to ask you a bit"},{"startTime":1810.59,"endTime":1812.36,"body":"about medical technologies now."},{"startTime":1812.36,"endTime":1814.67,"body":"I think you said that"},{"startTime":1812.36,"endTime":1814.67,"body":"CADTH have responsibility"},{"startTime":1814.67,"endTime":1817.79,"body":"for reviewing medtech products as well."},{"startTime":1817.79,"endTime":1820.07,"body":"What can you tell us about the process"},{"startTime":1820.07,"endTime":1822.74,"body":"and what are companies"},{"startTime":1820.07,"endTime":1822.74,"body":"that may be listening"},{"startTime":1822.74,"endTime":1825.023,"body":"in to this webinar need to know about?"},{"startTime":1826.37,"endTime":1829.1,"body":"- Yeah, I mean CADTH's"},{"startTime":1826.37,"endTime":1829.1,"body":"original remit was the Canadian"},{"startTime":1829.1,"endTime":1831.05,"body":"Coordinating Office for"},{"startTime":1829.1,"endTime":1831.05,"body":"Health Technology Assessment."},{"startTime":1831.05,"endTime":1833.9,"body":"It had no real drug remit per se,"},{"startTime":1833.9,"endTime":1838.07,"body":"although it did look at"},{"startTime":1833.9,"endTime":1838.07,"body":"drugs in its early days."},{"startTime":1838.07,"endTime":1841.67,"body":"But its real initial remit was technology,"},{"startTime":1841.67,"endTime":1843.413,"body":"funded by the federal government,"},{"startTime":1844.88,"endTime":1847.61,"body":"which is interested in appropriate use"},{"startTime":1847.61,"endTime":1849.65,"body":"of medical technology."},{"startTime":1849.65,"endTime":1851.33,"body":"And that has always been the case."},{"startTime":1851.33,"endTime":1854.39,"body":"And so CADTH has always actually assessed"},{"startTime":1854.39,"endTime":1856.01,"body":"medical technology, health technology."},{"startTime":1856.01,"endTime":1859.34,"body":"I mean, the definition of"},{"startTime":1856.01,"endTime":1859.34,"body":"health technology is broad."},{"startTime":1859.34,"endTime":1862.13,"body":"It's not simply commercialised"},{"startTime":1859.34,"endTime":1862.13,"body":"medical technology,"},{"startTime":1862.13,"endTime":1865.67,"body":"things like stents and the like."},{"startTime":1865.67,"endTime":1870.26,"body":"It could relate to procedures"},{"startTime":1865.67,"endTime":1870.26,"body":"or processes of care."},{"startTime":1870.26,"endTime":1873.89,"body":"CADTH has recently done, again,"},{"startTime":1870.26,"endTime":1873.89,"body":"an evaluation for example,"},{"startTime":1873.89,"endTime":1875.57,"body":"of emergency department overcrowding,"},{"startTime":1875.57,"endTime":1878.753,"body":"and interventions that could"},{"startTime":1875.57,"endTime":1878.753,"body":"be done to deal with that."},{"startTime":1879.65,"endTime":1884.03,"body":"But CADTH is also focused"},{"startTime":1879.65,"endTime":1884.03,"body":"on some high impact"},{"startTime":1884.03,"endTime":1886.64,"body":"technologies more recently."},{"startTime":1886.64,"endTime":1890.88,"body":"Things like newborn"},{"startTime":1886.64,"endTime":1890.88,"body":"screening programmes and"},{"startTime":1893.39,"endTime":1896.78,"body":"oh, and diagnostic technology."},{"startTime":1896.78,"endTime":1901.73,"body":"And so there's an interesting difference"},{"startTime":1901.73,"endTime":1904.82,"body":"between the medical"},{"startTime":1901.73,"endTime":1904.82,"body":"technology assessment process"},{"startTime":1904.82,"endTime":1906.443,"body":"and the drug..."},{"startTime":1906.443,"endTime":1910.46,"body":"Or there have been, historically,"},{"startTime":1906.443,"endTime":1910.46,"body":"interesting differences."},{"startTime":1910.46,"endTime":1914.06,"body":"Notably the medical technology"},{"startTime":1910.46,"endTime":1914.06,"body":"or health technology"},{"startTime":1914.06,"endTime":1917.0,"body":"assessment review process has typically"},{"startTime":1917.0,"endTime":1921.68,"body":"been more like the UK, sort"},{"startTime":1917.0,"endTime":1921.68,"body":"of an internal prioritisation"},{"startTime":1921.68,"endTime":1924.86,"body":"exercise working with payers to say,"},{"startTime":1924.86,"endTime":1926.78,"body":"what sorts of things"},{"startTime":1924.86,"endTime":1926.78,"body":"should we be looking at?"},{"startTime":1926.78,"endTime":1930.59,"body":"Not an application-driven process,"},{"startTime":1930.59,"endTime":1933.38,"body":"like the drug review process."},{"startTime":1933.38,"endTime":1935.96,"body":"However, more recently, CADTH,"},{"startTime":1935.96,"endTime":1937.28,"body":"which has become very innovative"},{"startTime":1937.28,"endTime":1940.07,"body":"and trying a lot of new things lately,"},{"startTime":1940.07,"endTime":1941.75,"body":"has actually opened this up."},{"startTime":1941.75,"endTime":1945.68,"body":"And they've done an"},{"startTime":1941.75,"endTime":1945.68,"body":"actual application-based"},{"startTime":1945.68,"endTime":1948.56,"body":"medical technology review,"},{"startTime":1945.68,"endTime":1948.56,"body":"or at least something"},{"startTime":1948.56,"endTime":1950.843,"body":"very similar to an"},{"startTime":1948.56,"endTime":1950.843,"body":"application-based review."},{"startTime":1951.77,"endTime":1954.89,"body":"They just released, actually"},{"startTime":1951.77,"endTime":1954.89,"body":"the other day, an assessment"},{"startTime":1954.89,"endTime":1959.72,"body":"of Optune, a medical"},{"startTime":1954.89,"endTime":1959.72,"body":"device for the treatment"},{"startTime":1959.72,"endTime":1962.183,"body":"of recurrent brain cancer."},{"startTime":1963.23,"endTime":1966.35,"body":"And so in doing that,"},{"startTime":1963.23,"endTime":1966.35,"body":"they're experimenting"},{"startTime":1966.35,"endTime":1967.82,"body":"with broadening things."},{"startTime":1967.82,"endTime":1972.77,"body":"But all that to be said,"},{"startTime":1967.82,"endTime":1972.77,"body":"medical technology,"},{"startTime":1972.77,"endTime":1976.04,"body":"commercial medical technology producers"},{"startTime":1976.04,"endTime":1978.83,"body":"are sometimes under the,"},{"startTime":1978.83,"endTime":1981.92,"body":"sometimes have the misunderstanding"},{"startTime":1978.83,"endTime":1981.92,"body":"that their first stop,"},{"startTime":1981.92,"endTime":1986.093,"body":"like in other countries is to"},{"startTime":1981.92,"endTime":1986.093,"body":"make an application to CADTH."},{"startTime":1986.93,"endTime":1989.72,"body":"And that's not necessarily the case."},{"startTime":1989.72,"endTime":1993.95,"body":"It typically, what they need to be doing"},{"startTime":1993.95,"endTime":1995.6,"body":"is going to individual regions"},{"startTime":1995.6,"endTime":1998.57,"body":"or large academic hospitals"},{"startTime":1995.6,"endTime":1998.57,"body":"and working with them."},{"startTime":1998.57,"endTime":2001.9,"body":"Some provinces, like the"},{"startTime":1998.57,"endTime":2001.9,"body":"province I live in, Ontario,"},{"startTime":2001.9,"endTime":2005.98,"body":"also have health technology"},{"startTime":2001.9,"endTime":2005.98,"body":"assessment processes."},{"startTime":2005.98,"endTime":2008.77,"body":"But again, they're not"},{"startTime":2005.98,"endTime":2008.77,"body":"necessarily application-driven."},{"startTime":2008.77,"endTime":2011.02,"body":"In some cases manufacturers"},{"startTime":2011.02,"endTime":2013.75,"body":"are given the opportunity to apply."},{"startTime":2013.75,"endTime":2015.31,"body":"It doesn't mean that they'll be assessed."},{"startTime":2015.31,"endTime":2016.84,"body":"So it means that they'd be put into"},{"startTime":2016.84,"endTime":2019.15,"body":"a prioritisation process."},{"startTime":2019.15,"endTime":2024.15,"body":"But there is no currently real"},{"startTime":2019.15,"endTime":2024.15,"body":"sort of application-driven"},{"startTime":2024.67,"endTime":2029.47,"body":"technology assessment process"},{"startTime":2024.67,"endTime":2029.47,"body":"that leads to reimbursement,"},{"startTime":2029.47,"endTime":2030.94,"body":"except for in the province of Quebec"},{"startTime":2030.94,"endTime":2034.387,"body":"where they have the NS process."},{"startTime":2034.387,"endTime":2038.89,"body":"And part of that is hospitals"},{"startTime":2034.387,"endTime":2038.89,"body":"in Canada are private,"},{"startTime":2038.89,"endTime":2040.42,"body":"not-for-profit institutions."},{"startTime":2040.42,"endTime":2044.65,"body":"And they're usually the ones"},{"startTime":2040.42,"endTime":2044.65,"body":"delivering medical, you know,"},{"startTime":2044.65,"endTime":2047.113,"body":"expensive and important"},{"startTime":2044.65,"endTime":2047.113,"body":"and medical technology."},{"startTime":2048.79,"endTime":2049.72,"body":"They're not beholden."},{"startTime":2049.72,"endTime":2052.27,"body":"They're given a budget,"},{"startTime":2049.72,"endTime":2052.27,"body":"a global budget envelope,"},{"startTime":2052.27,"endTime":2054.55,"body":"and they're not really beholden to anyone"},{"startTime":2054.55,"endTime":2055.96,"body":"to help administer that."},{"startTime":2055.96,"endTime":2058.3,"body":"They are administering"},{"startTime":2055.96,"endTime":2058.3,"body":"those funds themselves."},{"startTime":2058.3,"endTime":2061.96,"body":"So you know, they're"},{"startTime":2058.3,"endTime":2061.96,"body":"not beholden to Canada,"},{"startTime":2061.96,"endTime":2064.48,"body":"they're not beholden to even"},{"startTime":2061.96,"endTime":2064.48,"body":"their provincial funders"},{"startTime":2064.48,"endTime":2068.05,"body":"to run technology in any particular way."},{"startTime":2068.05,"endTime":2070.42,"body":"Where things get a bit tricky is when"},{"startTime":2070.42,"endTime":2073.18,"body":"a very expensive new technology comes in,"},{"startTime":2073.18,"endTime":2075.79,"body":"something like a proton beam therapy,"},{"startTime":2075.79,"endTime":2076.623,"body":"where the hospital says,"},{"startTime":2076.623,"endTime":2079.06,"body":"\"Well we can't carry that"},{"startTime":2076.623,"endTime":2079.06,"body":"with our current budget."},{"startTime":2079.06,"endTime":2080.41,"body":"We're really now going to have to work"},{"startTime":2080.41,"endTime":2082.12,"body":"with our provincial funders.\""},{"startTime":2082.12,"endTime":2084.167,"body":"And at that point the"},{"startTime":2082.12,"endTime":2084.167,"body":"provincial provinces might say,"},{"startTime":2084.167,"endTime":2086.59,"body":"\"Well, we need to really assess that.\""},{"startTime":2086.59,"endTime":2090.13,"body":"And if they have their"},{"startTime":2086.59,"endTime":2090.13,"body":"own assessment process,"},{"startTime":2090.13,"endTime":2091.75,"body":"they might use that."},{"startTime":2091.75,"endTime":2093.76,"body":"They also may ask CADTH to help them."},{"startTime":2093.76,"endTime":2097.3,"body":"So you know, I guess"},{"startTime":2093.76,"endTime":2097.3,"body":"it's important for people"},{"startTime":2097.3,"endTime":2100.96,"body":"to know that whereas"},{"startTime":2097.3,"endTime":2100.96,"body":"CADTH is doing this work,"},{"startTime":2100.96,"endTime":2104.32,"body":"it's not necessarily an"},{"startTime":2100.96,"endTime":2104.32,"body":"application-driven process,"},{"startTime":2104.32,"endTime":2107.77,"body":"and really depends."},{"startTime":2107.77,"endTime":2110.59,"body":"We did do a kind of"},{"startTime":2107.77,"endTime":2110.59,"body":"overview of the process"},{"startTime":2110.59,"endTime":2112.0,"body":"for the Institute of Health Economics."},{"startTime":2112.0,"endTime":2114.04,"body":"There's a document that people can access."},{"startTime":2114.04,"endTime":2115.69,"body":"It's getting a little older now,"},{"startTime":2115.69,"endTime":2118.633,"body":"but I think it still tells"},{"startTime":2115.69,"endTime":2118.633,"body":"you a bit of the story."},{"startTime":2119.47,"endTime":2121.84,"body":"And so that's, I think, important to know."},{"startTime":2121.84,"endTime":2123.31,"body":"But it's also important to know that CADTH"},{"startTime":2123.31,"endTime":2126.76,"body":"wants to expand the way it"},{"startTime":2123.31,"endTime":2126.76,"body":"looks at medical technology"},{"startTime":2126.76,"endTime":2131.503,"body":"and is currently looking at"},{"startTime":2126.76,"endTime":2131.503,"body":"application-based approaches."},{"startTime":2133.06,"endTime":2133.893,"body":"- Okay. All right."},{"startTime":2133.893,"endTime":2135.61,"body":"So, more changes there as well,"},{"startTime":2135.61,"endTime":2138.43,"body":"but it sounds like"},{"startTime":2135.61,"endTime":2138.43,"body":"engagement and understanding"},{"startTime":2138.43,"endTime":2141.133,"body":"of the different structures"},{"startTime":2138.43,"endTime":2141.133,"body":"can be very helpful."},{"startTime":2142.9,"endTime":2145.36,"body":"I wanted to come back to"},{"startTime":2142.9,"endTime":2145.36,"body":"rare disease strategy."},{"startTime":2145.36,"endTime":2147.46,"body":"You touched on this earlier."},{"startTime":2147.46,"endTime":2150.28,"body":"I think there was a rather"},{"startTime":2147.46,"endTime":2150.28,"body":"large investment last year,"},{"startTime":2150.28,"endTime":2153.46,"body":"one and a half billion,"},{"startTime":2150.28,"endTime":2153.46,"body":"into the first ever"},{"startTime":2153.46,"endTime":2156.52,"body":"national strategy for"},{"startTime":2153.46,"endTime":2156.52,"body":"drugs for rare diseases."},{"startTime":2156.52,"endTime":2159.52,"body":"And with the aim of that"},{"startTime":2156.52,"endTime":2159.52,"body":"being to improve access"},{"startTime":2159.52,"endTime":2163.57,"body":"and affordability for drugs to patients"},{"startTime":2163.57,"endTime":2165.67,"body":"with rare diseases in Canada."},{"startTime":2165.67,"endTime":2168.606,"body":"What's been the impact of this so far?"},{"startTime":2168.606,"endTime":2171.793,"body":"- (laughing) Well, that"},{"startTime":2168.606,"endTime":2171.793,"body":"depends on who you ask."},{"startTime":2172.99,"endTime":2176.47,"body":"Yeah, the $1.5 billion commitment"},{"startTime":2172.99,"endTime":2176.47,"body":"was from a few years back"},{"startTime":2176.47,"endTime":2178.42,"body":"and it's been carried"},{"startTime":2176.47,"endTime":2178.42,"body":"forward, carried forward,"},{"startTime":2178.42,"endTime":2180.13,"body":"as sort of..."},{"startTime":2180.13,"endTime":2183.16,"body":"I mean, it's kind of an"},{"startTime":2180.13,"endTime":2183.16,"body":"interesting conversation."},{"startTime":2183.16,"endTime":2187.0,"body":"1.4 was set aside to kind of"},{"startTime":2183.16,"endTime":2187.0,"body":"pay for the drugs themselves"},{"startTime":2187.0,"endTime":2189.55,"body":"over the course of years."},{"startTime":2189.55,"endTime":2192.67,"body":"And then there was about a"},{"startTime":2189.55,"endTime":2192.67,"body":"hundred million dollars set aside"},{"startTime":2192.67,"endTime":2196.21,"body":"to help bolster the"},{"startTime":2192.67,"endTime":2196.21,"body":"infrastructure required"},{"startTime":2196.21,"endTime":2200.86,"body":"to either evaluate, or"},{"startTime":2196.21,"endTime":2200.86,"body":"look into the development"},{"startTime":2200.86,"endTime":2203.23,"body":"of registries, and the like."},{"startTime":2203.23,"endTime":2205.36,"body":"So, it's been slow going."},{"startTime":2205.36,"endTime":2206.8,"body":"I mean, some people will"},{"startTime":2205.36,"endTime":2206.8,"body":"say it's been slow going."},{"startTime":2206.8,"endTime":2208.12,"body":"Some of those funds have been deferred,"},{"startTime":2208.12,"endTime":2210.52,"body":"deferred 'cause there's"},{"startTime":2208.12,"endTime":2210.52,"body":"nothing really concretely"},{"startTime":2210.52,"endTime":2213.31,"body":"up and running as of yet."},{"startTime":2213.31,"endTime":2216.43,"body":"However, there has been work"},{"startTime":2213.31,"endTime":2216.43,"body":"being done in the background."},{"startTime":2216.43,"endTime":2218.56,"body":"There's been extensive consultation"},{"startTime":2218.56,"endTime":2220.09,"body":"by the federal government in terms of,"},{"startTime":2220.09,"endTime":2221.38,"body":"well what does this look like?"},{"startTime":2221.38,"endTime":2222.253,"body":"What do we need?"},{"startTime":2223.6,"endTime":2228.6,"body":"And there are organisations"},{"startTime":2223.6,"endTime":2228.6,"body":"like CADTH, and CIHR,"},{"startTime":2229.27,"endTime":2233.98,"body":"our national health research"},{"startTime":2229.27,"endTime":2233.98,"body":"funding organisation,"},{"startTime":2233.98,"endTime":2238.98,"body":"looking to see how they"},{"startTime":2233.98,"endTime":2238.98,"body":"can bolster this process."},{"startTime":2240.4,"endTime":2242.62,"body":"I think one way of looking at this"},{"startTime":2242.62,"endTime":2247.62,"body":"might be a rare disease"},{"startTime":2242.62,"endTime":2247.62,"body":"strategy, or a rare disease..."},{"startTime":2247.84,"endTime":2252.52,"body":"It could come out through the"},{"startTime":2247.84,"endTime":2252.52,"body":"guise of national pharmacare"},{"startTime":2252.52,"endTime":2255.67,"body":"where we are now funding rare diseases,"},{"startTime":2255.67,"endTime":2257.8,"body":"or shoring up the"},{"startTime":2255.67,"endTime":2257.8,"body":"funding of rare diseases."},{"startTime":2257.8,"endTime":2262.603,"body":"So for example, as CADTH"},{"startTime":2257.8,"endTime":2262.603,"body":"makes a recommendation,"},{"startTime":2264.04,"endTime":2266.05,"body":"provinces collectively negotiate."},{"startTime":2266.05,"endTime":2268.09,"body":"Some provinces sign on quite early."},{"startTime":2268.09,"endTime":2271.0,"body":"A province like Ontario,"},{"startTime":2268.09,"endTime":2271.0,"body":"it has a lot of people,"},{"startTime":2271.0,"endTime":2272.89,"body":"and so ostensibly we'll have people"},{"startTime":2272.89,"endTime":2274.75,"body":"who have these rare diseases,"},{"startTime":2274.75,"endTime":2276.79,"body":"and they know that they"},{"startTime":2274.75,"endTime":2276.79,"body":"need to provide access."},{"startTime":2276.79,"endTime":2278.297,"body":"Some provinces might say,"},{"startTime":2278.297,"endTime":2280.9,"body":"\"We're not even sure if we"},{"startTime":2278.297,"endTime":2280.9,"body":"have anybody who has this,"},{"startTime":2280.9,"endTime":2281.97,"body":"so we're not even going to implement this"},{"startTime":2281.97,"endTime":2284.257,"body":"'cause it's a very expensive thing.\""},{"startTime":2286.99,"endTime":2288.797,"body":"And then a patient comes"},{"startTime":2286.99,"endTime":2288.797,"body":"around and actually says,"},{"startTime":2288.797,"endTime":2290.377,"body":"\"Well gee, I need this.\""},{"startTime":2291.28,"endTime":2295.69,"body":"So that can lead to some"},{"startTime":2291.28,"endTime":2295.69,"body":"inequity across the system."},{"startTime":2295.69,"endTime":2298.9,"body":"And I think what people"},{"startTime":2295.69,"endTime":2298.9,"body":"are thinking now is,"},{"startTime":2298.9,"endTime":2302.95,"body":"if anything a federal pharmacare funding,"},{"startTime":2302.95,"endTime":2303.79,"body":"what it could do..."},{"startTime":2303.79,"endTime":2305.32,"body":"Or federal, sorry, rare disease funding"},{"startTime":2305.32,"endTime":2309.52,"body":"could shore up differences"},{"startTime":2305.32,"endTime":2309.52,"body":"between provinces."},{"startTime":2309.52,"endTime":2311.89,"body":"But again, those things haven't been..."},{"startTime":2311.89,"endTime":2314.11,"body":"The details around that"},{"startTime":2311.89,"endTime":2314.11,"body":"have not been fleshed out."},{"startTime":2314.11,"endTime":2318.497,"body":"So we still don't have a bonafide..."},{"startTime":2321.04,"endTime":2322.03,"body":"I can't point you to anything"},{"startTime":2322.03,"endTime":2324.49,"body":"and say this is how it's going to work."},{"startTime":2324.49,"endTime":2328.0,"body":"Discussions are ongoing, however."},{"startTime":2328.0,"endTime":2329.77,"body":"But industry is involved to some extent"},{"startTime":2329.77,"endTime":2330.603,"body":"for those discussions."},{"startTime":2330.603,"endTime":2334.72,"body":"We have what's called an"},{"startTime":2330.603,"endTime":2334.72,"body":"implementation advisory group"},{"startTime":2334.72,"endTime":2338.23,"body":"that the federal government"},{"startTime":2334.72,"endTime":2338.23,"body":"has been hosting as a forum"},{"startTime":2338.23,"endTime":2340.69,"body":"for industry and other stakeholders"},{"startTime":2340.69,"endTime":2342.4,"body":"to discuss how could this all work."},{"startTime":2342.4,"endTime":2345.34,"body":"And so maybe they have"},{"startTime":2342.4,"endTime":2345.34,"body":"to do a little more,"},{"startTime":2345.34,"endTime":2347.98,"body":"It's been a bit slow"},{"startTime":2345.34,"endTime":2347.98,"body":"going, in the context of,"},{"startTime":2347.98,"endTime":2351.67,"body":"I think they've gone beyond their target"},{"startTime":2351.67,"endTime":2353.83,"body":"for where they wanted to be at."},{"startTime":2353.83,"endTime":2358.303,"body":"However, my understanding"},{"startTime":2353.83,"endTime":2358.303,"body":"is progress is being made."},{"startTime":2359.14,"endTime":2362.62,"body":"- Okay, that could be"},{"startTime":2359.14,"endTime":2362.62,"body":"another watch this space."},{"startTime":2362.62,"endTime":2365.2,"body":"I think there's a theme"},{"startTime":2362.62,"endTime":2365.2,"body":"there in rare diseases,"},{"startTime":2365.2,"endTime":2369.19,"body":"and possibly more broadly about"},{"startTime":2365.2,"endTime":2369.19,"body":"real-world evidence as well,"},{"startTime":2369.19,"endTime":2373.36,"body":"and more and more demand"},{"startTime":2369.19,"endTime":2373.36,"body":"for real-world evidence,"},{"startTime":2373.36,"endTime":2376.33,"body":"both to support previous decisions,"},{"startTime":2376.33,"endTime":2379.12,"body":"and see whether they were"},{"startTime":2376.33,"endTime":2379.12,"body":"the correct decisions,"},{"startTime":2379.12,"endTime":2381.52,"body":"or whether any new"},{"startTime":2379.12,"endTime":2381.52,"body":"decisions need to be made."},{"startTime":2381.52,"endTime":2384.82,"body":"But also to help make,"},{"startTime":2381.52,"endTime":2384.82,"body":"you know, make decisions"},{"startTime":2384.82,"endTime":2387.94,"body":"about patients with rare"},{"startTime":2384.82,"endTime":2387.94,"body":"diseases who may be relying"},{"startTime":2387.94,"endTime":2389.833,"body":"on registry data and so on."},{"startTime":2390.844,"endTime":2393.34,"body":"Is that something, has"},{"startTime":2390.844,"endTime":2393.34,"body":"there been many changes"},{"startTime":2393.34,"endTime":2396.94,"body":"in terms of that and setting up systems"},{"startTime":2396.94,"endTime":2399.13,"body":"and processes to analyse registry data"},{"startTime":2399.13,"endTime":2400.077,"body":"and real-world evidence?"},{"startTime":2400.077,"endTime":2402.52,"body":"And is that something our audience"},{"startTime":2402.52,"endTime":2403.933,"body":"might need to be aware of?"},{"startTime":2405.73,"endTime":2406.563,"body":"- Well, there have been."},{"startTime":2406.563,"endTime":2408.91,"body":"I mean, in the context"},{"startTime":2406.563,"endTime":2408.91,"body":"I did mention before,"},{"startTime":2408.91,"endTime":2413.44,"body":"CADTH has a post-marketing"},{"startTime":2408.91,"endTime":2413.44,"body":"drug evaluation programme."},{"startTime":2413.44,"endTime":2417.04,"body":"A key part of that is CADTH"},{"startTime":2413.44,"endTime":2417.04,"body":"sort of assumed control"},{"startTime":2417.04,"endTime":2420.25,"body":"of a previous programme"},{"startTime":2417.04,"endTime":2420.25,"body":"called the Drug Safety"},{"startTime":2420.25,"endTime":2422.2,"body":"and Evaluation..."},{"startTime":2422.2,"endTime":2424.0,"body":"Sorry, Drug Safety and"},{"startTime":2422.2,"endTime":2424.0,"body":"Effectiveness Network,"},{"startTime":2424.0,"endTime":2425.83,"body":"which is something from years back"},{"startTime":2425.83,"endTime":2428.5,"body":"that was set up by the federal government"},{"startTime":2428.5,"endTime":2431.41,"body":"as a way of looking at"},{"startTime":2428.5,"endTime":2431.41,"body":"safety and effectiveness."},{"startTime":2431.41,"endTime":2435.43,"body":"In its initial form, it was"},{"startTime":2431.41,"endTime":2435.43,"body":"sort of a little more focused"},{"startTime":2435.43,"endTime":2439.72,"body":"on pharmaco vigilance, pharmaco"},{"startTime":2435.43,"endTime":2439.72,"body":"epidemiology of safety."},{"startTime":2439.72,"endTime":2442.69,"body":"Now that it is in CADTH's hands"},{"startTime":2442.69,"endTime":2447.69,"body":"and more connected to drug"},{"startTime":2442.69,"endTime":2447.69,"body":"payer policy, it's shifted."},{"startTime":2447.7,"endTime":2451.75,"body":"It still has involvement"},{"startTime":2447.7,"endTime":2451.75,"body":"with the regulator"},{"startTime":2451.75,"endTime":2453.01,"body":"in looking at safety questions."},{"startTime":2453.01,"endTime":2455.53,"body":"But it also, probably more and more,"},{"startTime":2455.53,"endTime":2458.2,"body":"is looking at effectiveness questions."},{"startTime":2458.2,"endTime":2463.2,"body":"And I think people do see"},{"startTime":2458.2,"endTime":2463.2,"body":"bolstering that type of programme"},{"startTime":2463.24,"endTime":2468.24,"body":"as a way forward with"},{"startTime":2463.24,"endTime":2468.24,"body":"capturing, and looking at,"},{"startTime":2470.02,"endTime":2473.65,"body":"and assessing valuable"},{"startTime":2470.02,"endTime":2473.65,"body":"evidence, that is not part"},{"startTime":2473.65,"endTime":2478.12,"body":"of typical randomised control"},{"startTime":2473.65,"endTime":2478.12,"body":"trials that are meant to pass"},{"startTime":2478.12,"endTime":2481.81,"body":"regulators or, you know,"},{"startTime":2478.12,"endTime":2481.81,"body":"sometimes just meant to pass"},{"startTime":2481.81,"endTime":2486.81,"body":"the FDA and the MA, which,"},{"startTime":2481.81,"endTime":2486.81,"body":"you know, these are bodies"},{"startTime":2487.63,"endTime":2489.37,"body":"that make different types of decisions"},{"startTime":2489.37,"endTime":2493.303,"body":"that have no financial stake"},{"startTime":2489.37,"endTime":2493.303,"body":"in the decisions they make."},{"startTime":2494.26,"endTime":2498.04,"body":"So it's easier for them to"},{"startTime":2494.26,"endTime":2498.04,"body":"say yes to certain things,"},{"startTime":2498.04,"endTime":2501.1,"body":"where payers are saying,"},{"startTime":2498.04,"endTime":2501.1,"body":"well, we have no idea."},{"startTime":2501.1,"endTime":2503.71,"body":"So yeah, so there's a real recognition"},{"startTime":2503.71,"endTime":2504.94,"body":"that there's a whole bunch of real world"},{"startTime":2504.94,"endTime":2506.68,"body":"evidence that could help."},{"startTime":2506.68,"endTime":2509.41,"body":"And now CADTH's doing"},{"startTime":2506.68,"endTime":2509.41,"body":"things like finding out,"},{"startTime":2509.41,"endTime":2510.607,"body":"like what real-world"},{"startTime":2509.41,"endTime":2510.607,"body":"evidence is out there,"},{"startTime":2510.607,"endTime":2511.6,"body":"and like what registry..."},{"startTime":2511.6,"endTime":2514.75,"body":"So they have this project"},{"startTime":2511.6,"endTime":2514.75,"body":"looking at mapping"},{"startTime":2514.75,"endTime":2516.49,"body":"registries in Canada."},{"startTime":2516.49,"endTime":2519.04,"body":"They're coming out with"},{"startTime":2516.49,"endTime":2519.04,"body":"quality evaluation tools for,"},{"startTime":2519.04,"endTime":2521.59,"body":"here's how we're going to"},{"startTime":2519.04,"endTime":2521.59,"body":"assess real-world evidence,"},{"startTime":2521.59,"endTime":2523.1,"body":"here's how we're going to assess"},{"startTime":2524.02,"endTime":2528.22,"body":"data quality when we do find repositories"},{"startTime":2528.22,"endTime":2529.45,"body":"of real-world evidence."},{"startTime":2529.45,"endTime":2531.16,"body":"As I've mentioned before,"},{"startTime":2529.45,"endTime":2531.16,"body":"they're also looking"},{"startTime":2531.16,"endTime":2534.19,"body":"how can we work with industry stakeholders"},{"startTime":2534.19,"endTime":2537.46,"body":"so that there is a sharing of those data,"},{"startTime":2537.46,"endTime":2541.42,"body":"that maybe industry has that"},{"startTime":2537.46,"endTime":2541.42,"body":"payers and academic partners"},{"startTime":2541.42,"endTime":2542.953,"body":"don't have access to."},{"startTime":2543.79,"endTime":2547.783,"body":"So yes, I mean I think this"},{"startTime":2543.79,"endTime":2547.783,"body":"post-marketing drug evaluation,"},{"startTime":2548.62,"endTime":2551.77,"body":"real-world evidence is going"},{"startTime":2548.62,"endTime":2551.77,"body":"to become a bigger thing."},{"startTime":2551.77,"endTime":2555.22,"body":"It plays into a rare"},{"startTime":2551.77,"endTime":2555.22,"body":"disease strategy as well,"},{"startTime":2555.22,"endTime":2558.433,"body":"where I think people"},{"startTime":2555.22,"endTime":2558.433,"body":"recognise you often have drugs"},{"startTime":2558.433,"endTime":2563.11,"body":"that come to the table again"},{"startTime":2558.433,"endTime":2563.11,"body":"with, you know, regulatory"},{"startTime":2563.11,"endTime":2565.24,"body":"clinical trials that don't"},{"startTime":2563.11,"endTime":2565.24,"body":"answer a lot of questions"},{"startTime":2565.24,"endTime":2567.1,"body":"that payers are interested in."},{"startTime":2567.1,"endTime":2572.02,"body":"So we're going to see,"},{"startTime":2567.1,"endTime":2572.02,"body":"I think, more of that."},{"startTime":2572.02,"endTime":2575.05,"body":"Definitely both through"},{"startTime":2572.02,"endTime":2575.05,"body":"the rare disease strategy,"},{"startTime":2575.05,"endTime":2578.533,"body":"and then further on with"},{"startTime":2575.05,"endTime":2578.533,"body":"this Canadian Drug Agency."},{"startTime":2581.35,"endTime":2582.82,"body":"I'll stop there."},{"startTime":2582.82,"endTime":2583.69,"body":"- No, I think you're right."},{"startTime":2583.69,"endTime":2585.97,"body":"I think it's a trend"},{"startTime":2583.69,"endTime":2585.97,"body":"that's going to evolve"},{"startTime":2585.97,"endTime":2587.77,"body":"and change over time."},{"startTime":2587.77,"endTime":2590.26,"body":"Okay, so we're coming to"},{"startTime":2587.77,"endTime":2590.26,"body":"the end of our time now."},{"startTime":2590.26,"endTime":2593.203,"body":"I just wondered if you"},{"startTime":2590.26,"endTime":2593.203,"body":"had any closing comments,"},{"startTime":2594.16,"endTime":2597.49,"body":"you know, anything else"},{"startTime":2594.16,"endTime":2597.49,"body":"that you think our audience"},{"startTime":2597.49,"endTime":2601.0,"body":"might like to be aware of, or"},{"startTime":2597.49,"endTime":2601.0,"body":"any sort of inspiring comments"},{"startTime":2601.0,"endTime":2602.743,"body":"or lessons that they can learn?"},{"startTime":2607.39,"endTime":2608.223,"body":"- Well, a few things."},{"startTime":2608.223,"endTime":2611.53,"body":"I think, as I said, the kind"},{"startTime":2608.223,"endTime":2611.53,"body":"of tone and tenure of CADTH"},{"startTime":2611.53,"endTime":2615.19,"body":"has changed with sort of a"},{"startTime":2611.53,"endTime":2615.19,"body":"much better leadership now."},{"startTime":2615.19,"endTime":2618.55,"body":"And so, you know, you are"},{"startTime":2615.19,"endTime":2618.55,"body":"seeing a lot of openness."},{"startTime":2618.55,"endTime":2620.38,"body":"And I think people who"},{"startTime":2618.55,"endTime":2620.38,"body":"are living in the past"},{"startTime":2620.38,"endTime":2623.77,"body":"must now look at where they"},{"startTime":2620.38,"endTime":2623.77,"body":"are now and realise that CADTH"},{"startTime":2623.77,"endTime":2626.17,"body":"is actually trying a"},{"startTime":2623.77,"endTime":2626.17,"body":"whole bunch of new things."},{"startTime":2626.17,"endTime":2628.54,"body":"There's a lot more engagement."},{"startTime":2628.54,"endTime":2632.99,"body":"They will be coming out with an improved"},{"startTime":2635.697,"endTime":2638.864,"body":"deliberative process in coming months."},{"startTime":2640.51,"endTime":2644.23,"body":"You know, looking at international"},{"startTime":2640.51,"endTime":2644.23,"body":"best practises there."},{"startTime":2644.23,"endTime":2647.18,"body":"So, I think you're going"},{"startTime":2644.23,"endTime":2647.18,"body":"to see more standards"},{"startTime":2649.3,"endTime":2651.79,"body":"and an openness to kind of try and engage"},{"startTime":2651.79,"endTime":2655.06,"body":"and do new things on the CADTH side."},{"startTime":2655.06,"endTime":2658.12,"body":"In the background of all of"},{"startTime":2655.06,"endTime":2658.12,"body":"that, you're going to see,"},{"startTime":2658.12,"endTime":2662.953,"body":"potentially, this pharmacare,"},{"startTime":2658.12,"endTime":2662.953,"body":"Canadian Drug Agency,"},{"startTime":2664.3,"endTime":2667.21,"body":"and rare disease stuff advance."},{"startTime":2667.21,"endTime":2669.37,"body":"That's independent of CADTH, in a sense."},{"startTime":2669.37,"endTime":2670.66,"body":"CADTH's involved with those discussions,"},{"startTime":2670.66,"endTime":2675.25,"body":"but independent of that,"},{"startTime":2670.66,"endTime":2675.25,"body":"working in the background"},{"startTime":2675.25,"endTime":2678.463,"body":"between provinces and"},{"startTime":2675.25,"endTime":2678.463,"body":"the federal government."},{"startTime":2679.57,"endTime":2684.57,"body":"And you know, that could"},{"startTime":2679.57,"endTime":2684.57,"body":"ultimately result in a large,"},{"startTime":2685.0,"endTime":2687.73,"body":"federally administered"},{"startTime":2685.0,"endTime":2687.73,"body":"pharmacare programme"},{"startTime":2687.73,"endTime":2691.33,"body":"that is maybe filling in gaps."},{"startTime":2691.33,"endTime":2693.97,"body":"We don't know what it's"},{"startTime":2691.33,"endTime":2693.97,"body":"going to look like."},{"startTime":2693.97,"endTime":2695.95,"body":"There's no real design."},{"startTime":2695.95,"endTime":2700.153,"body":"So some people have ideas,"},{"startTime":2695.95,"endTime":2700.153,"body":"but we have no idea."},{"startTime":2703.293,"endTime":2706.66,"body":"And then, ostensibly,"},{"startTime":2703.293,"endTime":2706.66,"body":"also addressing questions"},{"startTime":2706.66,"endTime":2709.21,"body":"of rare disease and how we can make that"},{"startTime":2709.21,"endTime":2712.003,"body":"equitable across provinces."},{"startTime":2714.22,"endTime":2716.65,"body":"So yeah, there is going"},{"startTime":2714.22,"endTime":2716.65,"body":"to be a lot of change."},{"startTime":2716.65,"endTime":2719.4,"body":"I think there's a lot of"},{"startTime":2716.65,"endTime":2719.4,"body":"opportunities for involvement."},{"startTime":2721.6,"endTime":2723.76,"body":"And there may be, you"},{"startTime":2721.6,"endTime":2723.76,"body":"know, a great deal more"},{"startTime":2723.76,"endTime":2727.09,"body":"of transparency so that"},{"startTime":2723.76,"endTime":2727.09,"body":"companies like medtech companies"},{"startTime":2727.09,"endTime":2729.55,"body":"and pharmaceutical companies"},{"startTime":2727.09,"endTime":2729.55,"body":"who are maybe first time"},{"startTime":2729.55,"endTime":2732.1,"body":"in Canada and they're wondering"},{"startTime":2729.55,"endTime":2732.1,"body":"how does this all work?"},{"startTime":2732.1,"endTime":2734.35,"body":"It might become a little"},{"startTime":2732.1,"endTime":2734.35,"body":"easier to understand"},{"startTime":2735.46,"endTime":2737.74,"body":"in coming years."},{"startTime":2737.74,"endTime":2739.51,"body":"So, stay tuned for that."},{"startTime":2739.51,"endTime":2742.78,"body":"And yeah, be aware that"},{"startTime":2739.51,"endTime":2742.78,"body":"though things are evolving,"},{"startTime":2742.78,"endTime":2745.0,"body":"probably evolving, I"},{"startTime":2742.78,"endTime":2745.0,"body":"said it's a glacial pace,"},{"startTime":2745.0,"endTime":2748.18,"body":"but I think, like the"},{"startTime":2745.0,"endTime":2748.18,"body":"global warming situation,"},{"startTime":2748.18,"endTime":2749.56,"body":"glaciers are starting to move"},{"startTime":2749.56,"endTime":2750.97,"body":"a bit faster than they did before."},{"startTime":2750.97,"endTime":2753.88,"body":"So, yeah, you know, stay tuned,"},{"startTime":2753.88,"endTime":2754.99,"body":"I think, the next couple years."},{"startTime":2754.99,"endTime":2759.1,"body":"We have a federal election in"},{"startTime":2754.99,"endTime":2759.1,"body":"2025, so a lot of this stuff"},{"startTime":2759.1,"endTime":2760.39,"body":"could be happening before then."},{"startTime":2760.39,"endTime":2764.98,"body":"If it doesn't, and we have"},{"startTime":2760.39,"endTime":2764.98,"body":"a change in government,"},{"startTime":2764.98,"endTime":2767.35,"body":"they could also be, you know,"},{"startTime":2767.35,"endTime":2769.55,"body":"they could take the air"},{"startTime":2767.35,"endTime":2769.55,"body":"out of this as well."},{"startTime":2770.872,"endTime":2773.59,"body":"So there's a lot to keep track of."},{"startTime":2773.59,"endTime":2775.42,"body":"I haven't mentioned a lot about Quebec."},{"startTime":2775.42,"endTime":2778.453,"body":"I think Quebec is"},{"startTime":2775.42,"endTime":2778.453,"body":"increasingly participating."},{"startTime":2779.38,"endTime":2782.29,"body":"They are part now of the the Pan-Canadian"},{"startTime":2782.29,"endTime":2786.13,"body":"Pharmaceutical Alliance,"},{"startTime":2782.29,"endTime":2786.13,"body":"although they're still"},{"startTime":2786.13,"endTime":2788.2,"body":"doing all of their own"},{"startTime":2786.13,"endTime":2788.2,"body":"reviews and things like that."},{"startTime":2788.2,"endTime":2793.2,"body":"So Quebec is distinct in how they manage"},{"startTime":2793.81,"endTime":2795.76,"body":"a lot of health technology."},{"startTime":2795.76,"endTime":2798.34,"body":"And so just, I think people"},{"startTime":2795.76,"endTime":2798.34,"body":"need to be aware of that too,"},{"startTime":2798.34,"endTime":2800.35,"body":"that a lot of the things"},{"startTime":2798.34,"endTime":2800.35,"body":"I've been talking about"},{"startTime":2800.35,"endTime":2802.18,"body":"are more generalised with the CADTH,"},{"startTime":2802.18,"endTime":2804.943,"body":"and not necessarily to NS."},{"startTime":2807.884,"endTime":2809.5,"body":"- That's great. Thank you so much."},{"startTime":2809.5,"endTime":2810.88,"body":"That was really interesting."},{"startTime":2810.88,"endTime":2813.1,"body":"It sounds like there's"},{"startTime":2810.88,"endTime":2813.1,"body":"some changes coming up,"},{"startTime":2813.1,"endTime":2817.21,"body":"lots of positive things about"},{"startTime":2813.1,"endTime":2817.21,"body":"more openness and engagement."},{"startTime":2817.21,"endTime":2818.26,"body":"So, that was great to hear."},{"startTime":2818.26,"endTime":2821.2,"body":"Perhaps we'll have to schedule"},{"startTime":2818.26,"endTime":2821.2,"body":"another webinar in the future"},{"startTime":2821.2,"endTime":2824.35,"body":"when there's a bit more clarity"},{"startTime":2821.2,"endTime":2824.35,"body":"on some of these changes"},{"startTime":2824.35,"endTime":2827.53,"body":"and we can talk to you"},{"startTime":2824.35,"endTime":2827.53,"body":"about what's happening."},{"startTime":2827.53,"endTime":2829.12,"body":"Yeah, and thank you to the audience."},{"startTime":2829.12,"endTime":2831.01,"body":"Thanks for listening to our conversation."},{"startTime":2831.01,"endTime":2833.29,"body":"If there were any questions"},{"startTime":2831.01,"endTime":2833.29,"body":"that we didn't get to,"},{"startTime":2833.29,"endTime":2836.62,"body":"please get in touch with us"},{"startTime":2833.29,"endTime":2836.62,"body":"and we'd be happy to respond"},{"startTime":2836.62,"endTime":2838.84,"body":"and arrange of follow up with you."},{"startTime":2838.84,"endTime":2839.98,"body":"Yeah, thank you Don."},{"startTime":2839.98,"endTime":2842.83,"body":"Thank you everyone, and we'll"},{"startTime":2839.98,"endTime":2842.83,"body":"hope to see you again soon."},{"startTime":2844.45,"endTime":2846.01,"body":"Thank you for watching."},{"startTime":2846.01,"endTime":2848.23,"body":"If you'd like to find"},{"startTime":2846.01,"endTime":2848.23,"body":"out more about our work"},{"startTime":2848.23,"endTime":2851.17,"body":"or how we could support"},{"startTime":2848.23,"endTime":2851.17,"body":"your market access goals,"},{"startTime":2851.17,"endTime":2856.09,"body":"please email info@mtechaccess.co.uk,"},{"startTime":2856.09,"endTime":2860.263,"body":"or visit our website at mtechaccess.co.uk."}]}