Drug Coverage in Canada: How Medications Reach Your Medicine Cabinet

0:00 [Music]
0:02 foreign
0:05 Canada who we are we are a federally
0:08 registered charity supporting the 4.5
0:11 million Canadians who live with headache
0:14 or migraine and headache disorders
0:17 um
0:18 our mission is to improve the lives of
0:20 Canadians with migraine and other
0:21 headache disorders through advocacy
0:24 awareness education research and support
0:28 um before we start we just want to point
0:30 out that we do have the rest of our 2023
0:33 webinar series posted so please check it
0:36 out on our events page this includes on
0:39 October 16th our sleep and migraine
0:41 webinar
0:43 um we would be thrilled if everyone
0:45 continues to join our community you can
0:47 do that online at
0:49 migraincanada.org join uh we also
0:52 encourage you to check out our advocacy
0:55 page where there’s a lot of great
0:57 advocacy tools
0:59 um and also check out our our library
1:01 which are resources
1:03 um short two pagers for migraine
1:06 management
1:09 and before we begin
1:12 um something we say at the beginning of
1:14 every webinar is that we are simply
1:16 providing information not medical advice
1:19 and we want you to note that this
1:20 information presented and discussed
1:22 might not apply to your own situation uh
1:25 always discuss Medical Treatments with
1:27 your own health care provider who knows
1:29 your medical history
1:32 tonight we are very happy that Wendy
1:34 Gerhart will be presenting Wendy joined
1:37 migraine Canada as the executive
1:39 director in January 2021 her background
1:42 includes 25 years in the pharmaceutical
1:44 industry with experience in Market
1:46 access and stakeholder engagement
1:48 over the past seven years Wendy has been
1:50 a consultant serving in leadership and
1:52 project management roles with several
1:54 organizations she’s a strong advocate
1:57 for the highest patient outcomes public
1:59 and private medication access and care
2:01 and for shaping public policy
2:03 collaborating and championing change
2:05 within our fast-paced environment Wendy
2:08 is driven by her passion to improve care
2:10 for Canadians afflifted by migraine
2:14 so I’m really happy to be be with
2:19 everybody tonight and
2:21 um thank you Kaylee for the kind
2:22 introduction and uh information about
2:26 um our events that are planned for the
2:29 Q4 of 2023. who knew we were already
2:33 fast-paced into fall but here we are
2:37 um so for the next 30 minutes or so
2:41 um I’m gonna be talking as Kaylee
2:43 alluded to about the processes of how
2:47 our pharmaceutical medications are
2:48 approved and reimbursed in Canada under
2:51 the Public Drug programs
2:54 um uh provincial drug programs and then
2:57 we can have time for a q a throughout
3:00 I’ll pause a little bit
3:03 um at each section but then we can also
3:05 just regroup at the end
3:06 so plop your plop your questions into q
3:09 a
3:10 um we will not in this webinar be
3:13 discussing how devices or supplements
3:15 are approved because they go through a
3:17 completely
3:18 I shouldn’t say completely but they go
3:20 through a different process
3:22 um but uh I we want to focus tonight on
3:25 sort of how the pharmaceutical products
3:27 are brought to Market in Canada
3:31 um and will also not be really
3:32 discussing private insurance which we
3:35 did a webinar last I think it was last
3:37 year but um we can also do another one
3:39 coming up in 2024 but private insurers
3:42 is a completely different beast in
3:44 itself so we’re not going to really
3:46 touch on that tonight either so full
3:48 transparency guys although I have a lot
3:51 of experience and I a lot of knowledge
3:54 about reimbursement in Canada the
3:56 environment is very complex and there
3:58 are many
3:59 things that impact outcomes and
4:02 timelines so when we get to q a and
4:05 throughout the the the the presentation
4:07 I’ll do my best to answer your questions
4:09 if there’s anything I’m not confident in
4:12 answering I’ll follow up and make sure
4:14 that you get the ask the accurate
4:16 information that you’re you’re asking
4:18 for
4:19 um
4:20 I also want to just pause and just say
4:23 like what I’m presenting tonight is as
4:25 current as what I’m aware of things are
4:27 always changing and evolving
4:30 um and as I mentioned it’s a bit complex
4:31 and timelines are always changing and
4:34 that kind of thing
4:36 so with that I’m going to go on to
4:41 the next slide
4:44 why can I not Advance let me see there
4:48 we go so tonight what I’m going to cover
4:50 is
4:52 um
4:53 um how to access medications in Canada
4:56 for pharmaceutical medications who are
4:59 the stakeholders who are are making
5:02 decisions and
5:04 um making medications move through a
5:07 process to get actually from research
5:09 and development into our medicine
5:11 cabinets
5:13 um what are the drug approvals so what
5:16 is health health Canada’s role what is
5:19 the health technology assessment
5:20 processes which is catted and a Ness
5:23 which I know I use a lot of acronyms the
5:27 whole industry does and I put a little
5:29 Legend at the bottom just to let
5:31 everybody know exactly what cateth is
5:33 and I’ll go through that before we move
5:35 on to the next slide what are the
5:37 pricing negotiations that happened at
5:39 the pcpa and then what where do we have
5:42 opportunity to input the patient
5:45 perspective which is is relatively new
5:49 and it hasn’t been around for forever
5:52 um but it is definitely a welcomed input
5:55 it’s new it’s relevant it’s time
5:57 consuming we call on you for for input
6:00 and that kind of thing
6:02 and and not lastly but how can you help
6:05 what what is what is your role in your
6:07 communities to kind of help to raise
6:10 awareness and you know reach out and and
6:13 help to get
6:14 products available where you live and
6:18 lastly but not least we’ll we’ll loot
6:19 back for a q a so I just want to kind of
6:23 before I move on so cadith is the
6:26 Canadian Agency for drugs and
6:28 Technologies in health assessment
6:33 um Ness is similar to katith but it is
6:36 very specific to only Quebec and I’m not
6:39 going to try to interpret the um
6:45 um Annunciation of what it is but it I
6:48 I’ve spelled it out I I don’t speak
6:50 French so I would just be doing a very
6:53 huge Injustice
6:55 um and lastly pcpa is the pan-canadian
6:59 pharmaceutical Alliance and I’ll go into
7:00 more what their role is but um those are
7:04 the acronyms and
7:06 um
7:07 I’m not sure maybe I should have
7:09 probably just like cut and pasted this
7:11 into the chat so that everybody could
7:12 fall back on it but basically cadath
7:15 reviews Health technology assessment
7:18 and in us the same and then pcpa
7:22 negotiates price on behalf of provinces
7:26 all right I’m just going to pause very
7:29 quickly because I know we only have an
7:30 hour so is there any questions at this
7:32 point very specific to like the acronyms
7:35 or the institutions who review
7:40 so far we haven’t had any questions
7:41 Wendy often so I’m going to move on two
7:46 all right so how how do we access
7:49 medications in Canada so there are
7:52 virtually I put down virtually three
7:54 ways but I added in patient support
7:56 programs and I’ll get to that so they’re
7:58 really three formal ways to access
8:00 medications in Canada so there’s through
8:03 the public programs and there’s through
8:06 private insurance and there’s throughout
8:08 a path out of pocket so when referred to
8:11 public access this means where the
8:14 provincial governments provide product
8:17 through their formularies or drug
8:21 benefit plans every province is a little
8:24 bit different in how they name their
8:25 plans but it is it’s basically through
8:28 like the provincial
8:30 um the provincial plan
8:33 so approximately 20 of Canadians rely on
8:36 public plans
8:37 uh approximately 60 percent have private
8:40 insurance
8:41 and 10 of Canadians pay out of pocket
8:45 and I I I use the word approximately
8:47 because it also varies depending on the
8:50 province that you’re living in
8:53 um so that’s something just to to note
8:55 so in some provinces there might be more
8:57 people relying on the public plan and
8:59 there might be less on on in other
9:01 provinces
9:02 so public plans as I mentioned are paid
9:05 for and administered by the provincial
9:08 and territorial governments most of
9:10 these plans cover medications and
9:12 vaccines for eligible groups including
9:15 seniors recipients of social assistance
9:18 and individuals with conditions that are
9:21 associated with high drug costs many of
9:24 the drug many of the public plans also
9:27 have programs that cover costs of
9:30 certain types of medications or to cover
9:31 individuals with particular health
9:34 conditions
9:35 and or income thresholds
9:39 so private plans or sorry yeah private
9:42 insurance is covered
9:44 um is coverage provided by an employer
9:47 who offers benefits to their employees
9:49 and dependents so most large and
9:53 medium-sized employers offer benefits of
9:56 varying degrees and so navigating the
9:59 private payer world is equally or maybe
10:04 more complicated than the price than the
10:07 public system but uh we’re really not
10:09 going to dive into private insurance
10:11 tonight
10:13 and the third and least ideal option is
10:16 where Canadians have to pay out of
10:18 pocket this is the really unfortunate
10:20 place to be in
10:22 um an example of where an individual
10:24 might have to pay out of pocket is for
10:27 example if your household income is too
10:29 high or you’ve not met criteria
10:33 for that province’s listing and I’m
10:37 going to go into all this a little bit
10:38 more and I I don’t want to confuse
10:40 people so like I said please feel free
10:43 to kind of ask questions or wait maybe
10:44 till I get to that section and then ask
10:46 a question
10:48 um I did throw in a patient support
10:50 programs into this this slide because it
10:54 is an option to
10:56 help with financial assistance so
10:58 patient support programs are in place
11:00 they are they are owned and uh like
11:04 they’re owned by the manufacturers of
11:06 various
11:07 um medications
11:09 um and they’re really brought into place
11:11 to help with uh reimbursement navigation
11:15 and and to bridge people from the time
11:17 the prescription is written by the
11:19 clinician to the time when the private
11:21 insurance or the public Insurance
11:25 um funding is our coverage is in place
11:27 so for
11:30 I I wanted to highlight this here
11:32 because for people who choose to pay out
11:35 of pocket
11:36 um you may also be eligible for some
11:40 type of financial assistance and
11:42 generally it’s up to about 20 percent
11:44 which is what the co-pay is of private
11:47 insurance
11:48 it’s not going to cover the cost of your
11:51 medication but for some people
11:54 it gives you a little bit of financial
11:56 assistance and for other people it will
11:59 give you the opportunity to maybe try
12:03 try a medication and see if it works and
12:06 then and then
12:07 um try to figure out
12:10 paying for it on your own if you fall
12:12 into that out of pocket thing
12:16 so again tonight we’re just going to
12:18 focus on discussing public insurance and
12:20 the process that’s involved to get our
12:22 medication into your medicine cabinet
12:28 okay so there are five stakeholders
12:31 involved in people accessing medications
12:34 in Canada so Health Canada is at the top
12:37 of the of the totem pole if you will
12:39 it’s the regulatory body that provides
12:42 drug approvals for
12:45 um drug approvals in Canada based on
12:47 safety Clarity efficacy and quality if a
12:52 product goes through the health Canada
12:53 process and does not get an NOC and I’ll
12:56 go into that it’s not going to ever be
12:59 available in Canada so that is like sort
13:02 of the starting place for any medication
13:04 and device and supplement in Canada
13:08 we then have the patented patented
13:11 medicines price review board which is
13:14 acronym of pmprb it is an independent
13:17 body that sets the maximum allowable
13:19 price of all potential of all patented
13:23 medications in Canada
13:26 the price ceiling is is set based on its
13:29 assessment of the therapeutic value a
13:32 product brings to Canada and by doing a
13:37 comparison of prices with the price
13:39 sorry at the prices compared to other
13:42 countries who are marketing
13:45 um
13:46 uh the product
13:48 um despite how important this is and the
13:50 impact that it it has on bringing new
13:53 medications to Canada I’m not going to
13:55 go into any detail about this I’m happy
13:58 to I can’t hold a webinar on something
14:00 like this but I can certainly have like
14:02 an Instagram live event or a Facebook
14:04 live event just to kind of go into
14:06 explaining how prices are set in Canada
14:11 so
14:15 so for drugs and Technologies in health
14:17 it conducts a health technology
14:19 assessment as part of their common drug
14:22 review so you might often see the
14:25 acronym CDR which is common drug review
14:27 so it’s a process
14:29 um that provides public listing
14:32 recommendations
14:34 Health technology assessments are the
14:37 evaluations of clinical economic and
14:40 cost Effectiveness in addition to
14:42 patient and clinician evidence
14:44 uh and I’ll go we we have formal input
14:47 into this process and I’ll go into that
14:49 a bit more
14:51 um and I I’ll also refer to
14:53 um Ness as I talked about earlier
14:57 um it is very similar to katith but it
15:02 is very specific to Quebec and last but
15:06 not least is uh the pan Canadian
15:09 pharmaceutical Alliance so pcpa it is
15:12 the national body that is formed
15:15 um between the 10 provinces that
15:18 negotiate the actual drug prices
15:21 with the manufacturer
15:24 uh recommendations as a guide
15:27 um and then for the remainder of the
15:29 webinar again I’m going to refer to the
15:31 agencies using their acronyms so I
15:34 apologize if I might lose anybody but
15:36 this is recorded so you can go back and
15:38 then just lastly again
15:40 um private insurance companies they
15:42 control listings and reimbursement in
15:44 the private sector approximately 60
15:46 percent of the population
15:48 have private insurance
15:51 um and the majority of carriers have
15:54 begun building internal health
15:56 technology assessments and or managed
15:59 listing listing competencies based on
16:02 what comes out of the cadith and the NS
16:05 reviews
16:09 and on to the next slide
16:14 maybe was not advancing okay
16:18 so what is the drug approval process
16:20 look like in Canada
16:22 um so manufacturers need to go through a
16:25 lengthy research and development process
16:27 that includes Discovery pre-clinical
16:30 phase and then three phases of clinical
16:32 trials it sounds simple but it’s not a
16:36 it’s a very complex complicated process
16:38 from Doug from drug Discovery to your
16:41 medicine cabinet it takes between 50 10
16:44 to 15 years and millions even into the
16:48 billions of dollars to into research and
16:51 development depending on the um
16:54 the Innovative medicine uh the entire
16:57 process of completing all three phases
17:00 of this so that’s research Discovery
17:03 pre-clinical clinical and pharmaceutical
17:06 pharmacovigilance
17:09 um
17:13 anyways it takes it takes several years
17:16 takes lots of uh researchers patient
17:22 volunteers who are participating in the
17:24 clinical trials scientists doctors
17:27 researchers
17:29 um and at this point there’s really no
17:31 guarantee of success so there’s a huge
17:33 investment that the manufacturers are
17:36 putting into this process
17:38 um when a clinical trial for example
17:41 doesn’t show promise researchers go back
17:44 to the drawing board or they abandon the
17:47 the trial altogether and the product
17:50 will just never come to Market
17:53 um again we’re not going to go into any
17:54 more detail about
17:56 um clinical trials or that kind of thing
17:59 we can do a webinar
18:01 specifically on that if the community is
18:04 very interested so drug approvals so
18:06 once the clinical trials are completed
18:08 the first step is for the manufacturer
18:11 to submit the file to health Canada this
18:15 includes
18:16 like information on all the data from
18:18 the research and development of the
18:20 medication it’s a it’s a very
18:22 comprehensive package
18:25 um submissions are reviewed and assessed
18:27 for safety Clarity efficacy and quality
18:31 um during the review there’s regulatory
18:33 back and forth between Health Canada and
18:35 the manufacturer and then if the product
18:38 meets all of the requirements from
18:40 Health Canada then a notice of
18:42 compliance so an NOC or a notice of
18:45 compliance with conditions and nocc is
18:48 issued once the NOC is awarded the
18:52 product can then be sold in Canada
18:55 so we like an NOC
18:59 all right so now things get complicated
19:01 if they weren’t already so Canada’s
19:04 public reimbursement system as I
19:07 mentioned is very complex and it’s
19:08 challenging
19:10 um
19:12 the way things have evolved over the
19:14 years it’s really added layers of access
19:17 delays and and that kind of thing
19:20 um
19:21 so just as mentioned the drug
19:23 reimbursement system in Canada
19:26 um is is complex it has 19 distinct
19:30 Public Drug plans including Federal
19:32 provincial and territorial drug plans
19:35 and over 40 private insurance carriers
19:37 each with their own drug formulary so
19:41 that’s why I don’t even want to get into
19:43 the private sector tonight that’s a
19:46 whole other conversation the process
19:48 outlined on the slide that I will walk
19:50 you through takes approximately two to
19:52 two and a half years from NOC and we
19:55 already learned how many years it takes
19:57 to get through research and development
19:59 so
20:00 um
20:01 so from from NOC to get through the
20:04 process it takes
20:06 um approximately two to two and a half
20:07 years sometimes longer sometimes shorter
20:10 and we’re seeing a little bit of of both
20:12 happening with migraine medications
20:15 for public reimbursement purposes the
20:18 first step are the reviews at katith nns
20:21 and so those are the two Health
20:24 technology assessment agencies in Canada
20:27 where the outcomes slash recommendations
20:31 from uh Health Canada have significant
20:34 impact both review how the drugs
20:36 submitted for uh for review compares to
20:40 existing treatment options from both a
20:43 clinical and cost Effectiveness
20:45 perspective
20:49 um we then go on to the provinces the
20:52 provinces
20:54 um sort of well not sort of but at the
20:56 pcpa level
20:58 um then review the decisions based on
21:01 catathon and Ness
21:04 um as to whether they decide to engage
21:06 in negotiations with the manufacturer
21:08 through the pan-canadian pharmaceutical
21:10 Alliance which negotiates as I mentioned
21:13 the terms and outlines the specific
21:15 reimbursement conditions on behalf of
21:18 the public payers slash provinces
21:22 um and then lastly once the negotiations
21:25 between the manufacturer and the pcpa
21:29 office is completed
21:31 um individual provinces then move on to
21:35 decide whether to list the medications
21:37 on their formularies
21:39 um or not
21:41 at this point I also want to mention
21:43 which is really important is that it’s
21:47 not mandatory for all the manufacturers
21:51 um
21:52 to to actually go to
21:55 um cadith or to um
21:59 uh like pcpa so
22:02 um
22:03 for a few reasons they might decide to
22:06 just have their product reimbursed by
22:10 um private insurers
22:12 and that’s kind of another conversation
22:14 but it it’s not mandatory there’s no
22:18 um
22:19 um
22:20 like you have to do this whole process
22:23 so there are manufacturers I’ll give you
22:25 an example is for cambia and suevex that
22:29 manufacturer chose due to very probably
22:33 good valid reasons to not pursue the
22:37 public reimbursement pathway and so
22:40 those products are really only available
22:42 through the private insurance
22:45 um Channel
22:48 and then
22:49 um on the private pair side once a
22:52 product receives an NOC the manufacturer
22:55 starts to negotiations with each private
22:58 insurer carrier who has its own
23:00 formulary and then they conduct its own
23:02 review and decide its own reimbursement
23:06 criteria
23:08 um and the process for that is typically
23:10 not too bad
23:12 um it used to be
23:15 rather immediate but now it can take one
23:18 between one to nine months for a product
23:21 we were reviewed and listed depending on
23:23 the type of plans
23:25 um
23:26 that that insurance company is offering
23:30 um so I’m going to pause here is there
23:32 any questions that are coming in right
23:34 Wendy we do have a few questions
23:37 um so one question you made to backtrack
23:40 a bit
23:42 um one person’s asking if how and if
23:46 drug costs affect drug approval by
23:49 Health Canada Health and Welfare Canada
23:53 so Health Canada does not
23:57 um
23:58 there’s a simply on on safety clinical
24:02 that the price does not play a factor in
24:05 that and so that’s why sometimes you’ll
24:08 see a product who receives an NOC from
24:11 Health Canada
24:12 that it just might not end up on your
24:15 provincial drug plans because they’re
24:17 not reviewing it from a price
24:20 um perspective they’re just reviewing it
24:22 from safety clinical all of the
24:25 scientific
24:26 um perspectives
24:28 okay so then it’s at the provincial
24:30 level that they may decide not to
24:32 approve it because of cost
24:34 yes
24:35 okay
24:37 um
24:38 another question it’s specific to die 10
24:41 so I don’t know if we want to answer
24:43 this now or if it’s
24:46 better later on don’t ask away and I’ll
24:49 see if I can answer it now or I might
24:51 have to pull up something else to look
24:52 at it yeah our diet is ever going to be
24:56 approved in Canada if not why when they
24:58 are considered more beneficial for
25:00 seniors with migraine as they have less
25:01 cardiovascular risk
25:05 so the answer to that I do not know
25:08 offhand I would have to go back in my
25:12 notes and we’re just doing our quality
25:14 of life or sorry our our report card
25:16 launch and I do have information
25:18 specific to die towns so I’m probably
25:22 going to put this on hold and I might
25:24 just try and get back to this person or
25:26 to the larger group
25:28 um specific to this with more accurate
25:31 information like I said I I don’t have
25:33 everything front and center in front of
25:35 me because there’s just so many moving
25:36 pieces but I I will get back to you on
25:40 that
25:41 okay I’ll make a note of it
25:43 um we also have a question can you
25:45 explain what it means to add to
25:47 formulary
25:51 add to formulary yeah so
25:56 um adding to formulary means
26:00 um when the provinces have gone through
26:05 um the pcpa negotiation process and then
26:09 and I’ll go into this in a few slides
26:11 but
26:12 um and then they say yes and I’m just
26:15 going to use
26:16 Alberta as an example I live in Ontario
26:19 so Albert is a good Province to use
26:21 Alberta says yes we think this is a
26:24 really good relevant
26:27 um and important medication to add to
26:29 our portfolio of medications that we
26:32 cover they will they will add it to
26:35 their formulary then meaning that
26:37 doctors can prescribe and patients can
26:40 be re patients can be put on product
26:43 under the provincial program so paid for
26:46 by the government I hope that kind of
26:48 answers the question and again I’m
26:50 always happy to answer emails or
26:52 whatever but uh hopefully that kind of
26:54 answers the question okay the next
26:57 question and I think maybe a bunch of
26:59 people have been thinking this how did
27:01 the coveted vaccines the new antivirals
27:03 such as Pax lovid come to Market and
27:05 availability so quickly can this sped up
27:08 process used for the covid vaccines and
27:11 antivirals be used from now on
27:16 I do not absolutely do not have an
27:19 answer for that question but that is a
27:21 great question to get input in from our
27:24 scientific advisory committee who are
27:27 made up of healthcare professionals I’m
27:28 not a healthcare professional and I
27:30 can’t even begin to answer that but I
27:33 would be very interested in what they
27:35 have to come up with so let’s Kaylee
27:37 let’s park that and bring this to the
27:42 scientific committee to to weigh in on
27:45 okay and then one more question why are
27:48 triptans not covered in Ontario
27:51 ah
27:52 great question so we’re actually just
27:55 launching I’m kind of doing my my
27:58 presentation in different pieces but
28:01 we’re actually just launching our our
28:03 report card which is basically a
28:06 snapshot of what access looks like to
28:08 medications and Care in Canada
28:11 um so there’s no clear answer to that
28:13 and and when we launched the actual
28:15 report card you’re are going to see that
28:18 there are there’s not great coverage for
28:23 triptans basically in any Province
28:27 um which is something we have to be
28:30 working on because
28:32 to get to these more advanced therapies
28:34 you have to have tried and failed on
28:37 therapies and if they’re not available
28:40 through our public programs it’s kind of
28:43 hard to get experience to try and fail
28:45 on them
28:47 so
28:48 um
28:49 I don’t have an answer to your question
28:51 it’s
28:53 it’s just adds to the work that we need
28:55 to do to make trip towns which are in
28:59 large part genericize so they are
29:01 virtually no cost
29:03 to the to the province
29:06 um so we have a lot of work to do to
29:08 like make these all readily available so
29:11 that people can try and fail and move on
29:13 to the other medications
29:17 um hopefully that kind of answers your
29:18 question
29:20 if not email me and we can take it
29:22 offline or we can do some posts to
29:25 further explain this but
29:27 um that’s kind of the answer I’m sorry
29:31 okay thank you Wendy that’s all we have
29:33 for now okay
29:41 um
29:42 did I Advance a slide or no
29:46 all right so caddeth so we’ve already
29:50 talked about what Kev stands for
29:54 um so what is the submission review
29:56 process so manufacturers submit to
29:59 katith nns
30:01 um typically mostly
30:04 around the same timelines
30:06 um so and they review based on health
30:09 technology assessments so that’s the
30:11 whole acronym HTA it’s a review of The
30:14 Clinical and cost Effectiveness analysis
30:17 of the product and and each of these
30:20 institutions katith nns they also
30:24 um they solicit patient and clinician
30:27 inputs so this is where migraine Canada
30:30 and the Canadian Headache Society and
30:32 migraine Quebec all provide input into
30:36 um the submissions that that’s gone in
30:38 on that specific product
30:41 um the manif it goes It goes through a
30:44 bit of a back and forth in the
30:45 manufacturer has a chance to respond to
30:47 recommendations before it’s made in
30:48 public
30:50 um
30:50 groups like migrant Canada and Canadian
30:53 Headache Society and migraine Quebec we
30:55 also have a chance to weigh in on
30:58 recommendations that come out of that at
31:00 the end of the day there it concludes
31:03 with a recommendation
31:04 based on criteria of whether to
31:08 um
31:09 reimburse or not reimburse
31:16 all right and then once the katith
31:19 recommendations are made public
31:21 and I told you everybody this is a long
31:23 process it’s lengthy it’s very
31:25 complicated once the cat is
31:27 recommendations are made public the file
31:30 then goes into a Queue at the pcpa so
31:33 the pan Canadian pharmaceutical Alliance
31:37 and remember that the pan that the pcpa
31:41 based on the caddeth
31:43 criteria negotiates price with the
31:46 manufacturers and I’m slowing right down
31:48 because I know I talk very fast but I
31:51 want you to understand that so
31:53 the pcpa negotiations are based on the
31:57 caddeth criteria and they negotiate
32:00 price with the manufacturers
32:04 until the negotiations commence the file
32:07 is kind of like I said it’s in a queue
32:09 and it’s considered under under
32:11 consideration when the provinces are
32:13 ready to pick up the file and start
32:14 negotiations an engagement letter is
32:17 then issued to the manufacturer and the
32:19 negotiations commits once the pro one
32:22 Province will actually take the lead in
32:25 the negotiations and it could be
32:29 could be Nova Scotia it could be BC it
32:31 could be Alberta it could be
32:34 um any any province
32:37 um and they they lead though they they
32:39 lead those negotiations on behalf of the
32:42 provinces
32:44 all having conversations with the
32:46 various provinces obviously because they
32:48 are weighing in on the price that
32:50 they’re willing to pay so
32:53 um at this point I just want to mention
32:55 that like
32:57 that not all provinces
33:00 need to opt in to negotiations
33:05 so provinces can
33:08 choose to opt out or choose to opt in
33:12 when a province opts out it generally
33:16 means that the province has no intention
33:18 of listing and it will not negotiate
33:21 separately with the manufacturer
33:24 this is like a bad news story for our
33:27 community
33:29 um it doesn’t happen often
33:31 but it it has happened so
33:36 um and the other thing just to note is
33:38 that the manufacturer or or public do
33:41 not really know which provinces are at
33:43 the table during these negotiations
33:47 um some considerations so when I I think
33:51 probably a question that is brewing
33:52 through people’s minds is so what are
33:54 the considerations as to
33:57 um when like negotiations will start or
34:00 how fast they’ll start or or even why
34:03 they’ll start so some of the some of the
34:05 considerations given is the cadith or
34:09 the NS recommendations
34:12 um is there is there therapeutic gaps in
34:15 care what is the budget impact
34:19 analysis so we call it a Bia what is the
34:22 budget impact analysis on what it what
34:24 this product is actually going to cost
34:27 um a province
34:30 um the therapeutic landscape the current
34:33 coverage of alternative drugs and so in
34:37 in migraine we know that a lot of the
34:39 older medications which are what we’ve
34:42 only had exposure to are you know they
34:45 weren’t even designed to treat migraines
34:49 so
34:50 um you know we have a we have a fresh
34:53 kind of offering of medications that
34:57 have been designed to treat
34:59 um migraines so you know there should be
35:02 no issues with that
35:04 um and that’s about it and so when
35:07 negotiations are successful so after
35:10 give and take through the manufacturer
35:12 and and I’m not at the table nor any
35:15 patient organization in any of these
35:17 it’s all confidential so when
35:19 negotiations are success successful a
35:22 letter of intent so we call it an Loi is
35:25 awarded
35:27 and when negotiations conclude without a
35:30 letter of intent the next step is is
35:33 really
35:35 um
35:36 that that negotiations are not going to
35:40 proceed within the provinces like
35:42 there’s not going to be listings
35:45 um in most cases that’s not to say in
35:47 all cases but in most cases
35:52 um and it’s important to note that um
35:55 once negotiations are concluded
35:58 and even if a province opted in it
36:01 doesn’t automatically mean that the
36:04 province is going to actually list
36:07 so
36:09 at the end of the day a province might
36:11 just go no we’re not going to do this
36:15 um
36:19 and yeah I think that’s kind of all I
36:22 had to say
36:24 about this
36:26 so is there I’m gonna go stop and pause
36:29 is there any questions about the pricing
36:32 negotiations or the process that’s
36:34 involved with this
36:37 um we do have a few questions about
36:39 different treatments
36:41 um the only one related to pricing
36:44 is do the price of new drugs eventually
36:48 come down for example my first a jovi
36:51 dose was quoted at about 629 dollars
36:58 um so without talking with this person
37:03 um kind of privately
37:06 um I would have to learn more about
37:09 where they got their quote from but
37:13 like kind of generically speaking the
37:18 prices will not come down like they’ve
37:20 the manufacturers have negotiated pretty
37:23 low
37:25 um
37:27 based on
37:28 like pmprb pricing and then bulk pricing
37:32 which is what the pcpa negotiations are
37:36 about so there’s not going to be a lot
37:39 of lower
37:40 like like they don’t discount their
37:43 medications they’re they’re pretty
37:45 you’re getting that price is probably
37:47 the lowest that it it will it will go
37:50 until and maybe we’ll get a little bit
37:54 into this if we have time but like
37:56 like brand name Innovative
38:00 pharmaceutical companies who bring these
38:02 new medications to Market
38:05 um they have a patent so when the patent
38:09 runs out then the generic manufacturers
38:13 will start to manufacture at a
38:16 significantly reduced price which yes
38:20 will bring down the price of the
38:22 medication uh longer term but we’re
38:24 pretty we’re pretty new in the life
38:26 cycle of the medications so the it’s
38:29 going to be several years before we see
38:32 generics kind of step in and
38:35 bring down the price of these newer
38:38 Innovative medications I I hope that’s
38:40 helpful
38:42 okay thank you Wendy
38:45 oh boy we have a lot of slides together
38:47 okay so the point the patient voice the
38:49 quotient voice the patient voice
38:52 um so we already talked kind of about
38:54 all of the people the stakeholders
38:58 involved to get the product through the
39:01 pipeline so where we have formal patient
39:05 input so where I actively seek your
39:08 input to design submissions and that
39:11 kind of thing are at cadith and s i
39:14 partner with migraine Quebec and also BC
39:16 has their separate formal process other
39:19 than that everything else is very
39:21 informal and I’m advocating on a regular
39:24 basis without reach to the provinces and
39:26 through pcpa to talk about
39:28 why we need new medications you know we
39:31 don’t have a lot of options for migraine
39:34 care
39:35 um and that kind of thing and so just to
39:38 highlight again you know from Health
39:40 Canada to where we see negotiations and
39:44 with the p uh pcpa is about 2.5 years so
39:49 we’ve already seen the time it takes to
39:51 get through research and development and
39:54 now we’re seeing another 2.5 years so
39:56 just emphasizing how long it takes to
39:58 actually get a medication into
40:03 where you can like purchase it or be
40:06 prescribed it or that kind of thing
40:11 um well sorry I didn’t realize I had
40:13 built in all these so yeah I’m just
40:15 gonna go through all these okay so just
40:18 recapping kind of on where we are today
40:20 there’s been four Revolutions of
40:22 migraine care in Canada so in the 1990s
40:25 we had the trip Downs come in 2011 we
40:28 had Botox come
40:30 cgrps came to Market starting in 2018
40:33 and now we’re recognizing in 2022 the G
40:36 pound so we’ve had a lot of new
40:39 medications but we had a good Gap in
40:42 where there was no new medications
40:44 coming to care
40:46 um so I just want to give you kind of a
40:48 snapshot of what that looked like
40:52 so what does our current environment
40:53 look like guys so uh this is the world
40:56 that I really live in like I’m up to my
40:58 I would say far beyond my knees maybe up
41:01 to my elbows in but um here’s the
41:04 current environment so if you look
41:06 across
41:07 um the table that I have
41:10 um here’s the medications that have gone
41:11 through Canada so we have botox a jovi
41:14 amavig and gallity VIP tea and qualipta
41:18 um
41:19 nurtek is on the horizon you bralvi
41:25 um
41:25 I’m not completely sure where Abby is
41:28 going with submitting to katith but I
41:30 think it’s going to happen
41:32 um
41:34 so we we have a nice uh
41:37 flashlight of green Happening Here
41:40 when we look at the PCB pcpa
41:42 negotiations Botox got a red X Adobe
41:47 green amavig red X
41:55 is actually just being negotiated as we
41:58 speak and our Tech of course is
42:01 um to be determined because they have
42:03 not received NOC yet
42:06 um so
42:09 what I do want to highlight just to
42:11 bring to everybody’s consideration is
42:14 even though Botox got X at pcpa
42:18 negotiations they do there is like
42:21 General coverage open means like there’s
42:25 no criteria to be met in Alberta Ontario
42:28 has criteria and Quebec has criteria
42:32 um so at least those are options for
42:35 people who live in those provinces the
42:37 rest of the provinces there’s no
42:38 coverage there’s it’s not
42:41 that’s not an option
42:44 um ijovi is listed now in all provinces
42:47 it has decent criteria and it also
42:52 um we’re working on trying to improve
42:54 subsequent
42:57 um approval timelines
43:00 um so we’re moving we’re trying to move
43:01 those from six months after the first
43:05 approval to 12 months just meaning we’re
43:08 working on it requiring basically less
43:11 paperwork for your Healthcare
43:13 professional
43:14 um from six months to one year
43:17 amavic is not a not a question not a
43:20 conversation mgality is now listed in
43:23 all the provinces
43:25 um and vayepti who just received their
43:28 you know or sorry their um their pcpa
43:32 um letter of intent uh I think it was in
43:35 June I have it on the next slide
43:38 um we’re recognizing coverage in Alberta
43:40 Ontario Quebec New Brunswick Nova Scotia
43:43 now we do know
43:45 um for vayapti that BC is a troubling
43:49 province in that they opted out of the
43:52 negotiation so I’m doing a lot of work
43:55 independently of lundbeck to um
44:00 um to
44:02 have conversations with the provinces
44:04 and you know talk about the need for
44:06 medications and and all of that kind of
44:09 thing but uh that is a red flag on my
44:11 to-do list
44:13 uh and again we’re just waiting and
44:15 seeing nerd Tech and you briefly so
44:18 that’s the lay of the Land There
44:21 and I just wanted to kind of highlight
44:22 the some of the timelines because I
44:24 think it’s important people recognize
44:26 how long it takes to actually move
44:30 um a product review through the
44:32 processes so you know I’m not going to
44:34 go over this in detail because I’m just
44:36 being really cognizant of the time
44:38 um but it it it it takes months
44:42 um and in some case
44:43 cases like a lot of months
44:47 um and then in some cases you know the
44:50 manufacturer and me
44:52 invest a lot of time in in conversations
44:55 and that kind of thing to end up without
44:57 an Loi
45:00 so
45:01 um
45:03 the one thing I did want to highlight is
45:05 that to date that pcpa has been in
45:08 existence and that’s several years now
45:10 they’ve completed 642 negotiations and
45:15 550 of those have concluded with a
45:17 letter of intent and only 92 have
45:20 concluded without an Loi so when I do my
45:24 math and I I have a a student a
45:28 university student helping us out who’s
45:30 working on this like
45:32 I read it as 80 86 ended in an Loi
45:36 compared to recent migraine treatments
45:39 where only 60 percent added ended in an
45:44 Loi so I find that like there’s a lot of
45:46 inequities and I think it speaks to the
45:50 amount of work that we need to do to
45:53 make migraine really A Conversation
45:56 Piece and respect it and and relevant
46:00 into the conversations of why we need
46:02 new medications
46:04 I’m going to pause there and just ask if
46:06 there’s any questions
46:09 hi Wendy yes we do have some just
46:12 quickly
46:13 uh someone asked the you Bradley
46:15 categories blank sorry I must have
46:17 missed why no approval
46:19 yeah so you bralvi is approved in Canada
46:25 like it has an NOC but the manufacturer
46:29 has chosen
46:31 um and I can’t get into the specifics of
46:34 why but there’s just a pause on whether
46:37 and I think they will eventually
46:41 um submit to katith but
46:43 um there’s just a pause on actually
46:46 submitting to cadith but it is available
46:49 for sale in in Canada so if you have
46:55 private insurance
46:57 you may have access to it but just not
47:01 again we’re talking about public right
47:03 now so just not through the public
47:05 system
47:06 so happy to if this person wants to
47:09 email me for more information we can
47:11 chat offline but that’s the nuts and
47:14 bolts of of that
47:17 okay and um will migraine modulation
47:19 devices ever be readily available in
47:22 Canada at a pharmacy or from a doctor
47:24 such as cephaly or gamma core
47:26 yeah so really good question
47:32 um
47:33 so
47:35 I mean
47:37 I have so many things to advocate for
47:40 like that’s part of what our report card
47:42 will show and demonstrate is that
47:45 yeah like devices should be a part of a
47:51 treatment regimen
47:52 but I’m going to answer your question so
47:54 no there are there there they are not
47:59 reviewed at the moment by
48:05 and therefore not through the Public
48:07 Drug plans
48:08 it is my goal that we do have these
48:13 treatments because they are a treatment
48:14 and they’re effective
48:17 um longer term
48:19 to go through this process but they do
48:22 have their own separate
48:25 um
48:25 mechanism of being approved through
48:28 Health Canada so that they can be
48:30 distributed in health Canada
48:33 but there’s yeah there’s no and and
48:36 there’s no private insurers that to my
48:38 knowledge that cover devices and I I
48:42 totally think that they should
48:44 um because there’s lots of people who
48:46 need a little add-on to a pharmaceutical
48:48 or they don’t want to take a
48:50 pharmaceutical and this is effective for
48:52 them and there’s lots of Pediatrics who
48:55 like let’s face it parents don’t want to
48:58 pump meds into their kids so they would
49:00 like to try a device versus
49:03 and I hope that my pharmaceutical
49:06 friends don’t don’t Sue or me for that
49:09 for that comment but the reality is I
49:12 think those two devices need to have a
49:15 playing field in the Canadian Market
49:18 to supplement or to you know for people
49:21 who are just like treatment naive and
49:23 they just don’t respond to the Pharma
49:24 pharmacologics I think the the devices
49:27 are a good option and for those that it
49:30 works
49:32 they should have access to them
49:36 what about
49:37 um supplements like B2 magnesium CoQ10
49:41 they are recommended by neurologists for
49:44 migraine
49:45 um
49:46 they’re non-prescription and they can’t
49:48 be submitted in income tax filing does
49:51 migraine Canada Lobby for coverage
49:54 we talk about it I I to be fully
49:58 transparent right now is just trying to
50:00 get these new medications that are
50:03 available like recognized acknowledged
50:07 listed
50:08 um longer term and it’s not that it’s
50:10 not something that we talk about and I I
50:13 don’t have a slide on it of the
50:14 importance of the um the supplements
50:17 they again go through a different
50:19 process
50:22 um
50:23 trying to get those included into a
50:28 formulary
50:29 is really uncharted waters for me but
50:32 it’s definitely not something I’m not
50:34 going to go down because I know that
50:37 lots of doctors prescribe the
50:39 supplements either in conjunction with
50:43 income in combination with or even on
50:46 their own because some people just don’t
50:47 want to take pharmacologic medications
50:49 and so and so for some people having
50:53 just taking some of these supplements it
50:56 works for them so again I’m all about
50:59 access to all of these treatment options
51:02 and who is really anybody making
51:05 decisions to decide what is what what is
51:09 reimbursed what is not I think they
51:11 should all be so that’s kind of where I
51:13 come from is every medication or
51:17 supplement or device that a doctor and a
51:20 patient are talking about those should
51:22 be available
51:25 um
51:26 I hope that answered kind of your
51:28 question I’m not sure if it did or not
51:30 but yeah we have a lot more questions
51:32 coming in Wendy okay
51:35 um
51:36 I think this may resonate with a lot of
51:38 people I am currently taking kulipta and
51:41 has been helpful for me the only thing
51:43 that has been so far for prevention
51:45 however I’m paying out of pocket for the
51:48 medication and my work benefits don’t
51:50 cover unfortunately out of pocket for me
51:52 is a quarter of what I make in a year
51:54 and it’s not sustainable for me long
51:56 term with our current economic
51:57 circumstances
51:59 are there other options to get this
52:00 medication covered publicly or even some
52:02 partial financial support in the public
52:04 sector I find it confusing why
52:07 medication wouldn’t be covered when the
52:08 cost of individuals having to stop
52:10 working and apply for ODSP would be much
52:13 greater costs if we cannot function
52:14 right or work due to not having access
52:17 of needed medication
52:20 yeah that’s a great question so as as as
52:24 I have noted on the slide here it does
52:27 have a positive recommendation through
52:29 Cadiz
52:31 um it is under negotiation through
52:35 pcpa
52:37 um sorry is does this person have
52:41 private insurance
52:45 I believe so okay so relying on the
52:49 public system
52:50 so my work benefits don’t cover the
52:53 medication okay so the person has
52:56 private insurance so
52:59 um depending on where you’re living
53:02 and who your employer or your spouses or
53:06 Partners employer
53:08 has coverage through it may just be that
53:12 migraine medications are not covered on
53:15 that particular plan and I’m gonna get
53:17 into a little bit about private
53:19 insurance in a few slides
53:21 um
53:22 and I I should probably just do a
53:24 completely separate
53:26 webinar on advocacy but
53:29 um
53:29 kind of Park that question so the long
53:32 answer short is for public reimbursement
53:35 it’s going through pcpa so there is no
53:40 current
53:41 um
53:42 reimbursement publicly I do know
53:45 qualipto has
53:47 decent coverage through private drug
53:51 plans so what that means is that the
53:56 manufacturer has done a checkbox saying
53:58 Canada Life or Sun Life or manual life
54:00 is covering our product
54:03 what that does not mean is that it’s
54:06 translating down into your employer
54:09 saying I want to include migraine
54:12 medications
54:13 in the benefit package I’m offering John
54:17 or Joe
54:19 hopefully that makes sense like it’s so
54:21 complicated I’m sorry guys I don’t know
54:22 how to make it simple because it’s not
54:25 so that might be where you’re getting
54:29 caught up and maybe you can email me
54:31 offline and we can kind of talk this
54:33 through a little bit more
54:35 thank you Wendy
54:38 um the next question is to what extent
54:40 is transparency a factor in the price
54:43 negotiation process given that the same
54:45 medication can be cheaper in Canada than
54:47 the US and more expensive than in New
54:49 Zealand or Australia
54:51 yeah so that comes down to
54:54 um the pricing the pmprb pricing
54:57 guidelines who p and prb sets the price
55:03 um
55:04 with with the with input from the
55:06 manufacturer of what it can be sold for
55:09 in Canada
55:12 and so
55:14 sometimes
55:16 and thankfully not too often
55:20 if a price so I’m going to compare it to
55:23 the state so if if a product is being
55:26 sold to the states at a certain price
55:28 and Canada is not willing to
55:32 sell at that price
55:34 sometimes the manufacturer will just
55:36 choose not to bring the product to
55:38 Canada
55:39 and that’s the reality that we’re living
55:41 in and it’s not a good reality so
55:47 to the question of the transparency of
55:49 the pricing is is we can see what
55:53 it’s pretty transparent what the price
55:55 is in certain provinces
55:58 but that’s not the actual price because
56:00 when you go to your
56:04 um
56:05 when you go to your Pharmacy they they
56:08 add on their Pharmacy prices and that
56:10 kind of thing that’s why we we’ve done
56:12 away with listing prices on our website
56:14 is because it can fluctuate if you go to
56:17 Costco and again I’m going to pick on
56:19 Alberta I don’t know why I’m from
56:20 Melbourne I live in Ontario but I’m from
56:22 Melbourne so if you go to Alberta and
56:24 you go to Costco they might give you a
56:26 price of I don’t know 600 for a jovi I’m
56:30 I’m totally making this up and then you
56:32 go to Safeways and they’re going to give
56:34 you a price of
56:36 520.
56:38 why is there a difference it’s because
56:40 of their pharmacy market
56:41 that’s something we don’t have control
56:43 over
56:44 um well nobody has control over it’s up
56:46 to the pharmacy Network
56:49 um
56:50 but by and large
56:53 the prices that the provinces are
56:56 listing I might have to check this I
56:59 think they’re fairly
57:02 trans no I think they’re not transparent
57:05 and that’s why you see the fluctuations
57:07 in price at the pharmacy because you
57:08 don’t know what that markup is
57:10 I might follow up with um just some
57:12 concrete information on that so I am not
57:15 leading anybody down the wrong road
57:17 there
57:18 thank you Wendy
57:21 um all these follow-ups right Kaylee I
57:23 think so yeah
57:27 so the next question
57:30 I’m thankful I don’t have 15 or more
57:32 migraines per month however this
57:33 disqualifies me from many medications I
57:36 do have five to eight which still
57:38 negatively impacts my life I’ve tried
57:41 many medications both preventative and
57:43 acute care that have not been effective
57:45 for me are there other options
57:49 that’s uh
57:51 your question is is great and I think
57:55 um before I could even offer any advice
57:58 that I can offer medical advice I’m not
58:00 a clinician
58:01 um
58:02 I would have to have like a one-on-one
58:04 conversation with you and kind of direct
58:06 you maybe how to have that conversation
58:08 with your clinician
58:10 um
58:13 that’s probably the best way I can
58:14 answer that question all right I’ll give
58:16 them our contact information
58:19 quickly Wendy if you could go through
58:22 and label each of these medication
58:24 options as either daily preventive or
58:27 rescue medication so that people can get
58:29 an idea of what they are
58:31 okay go to our website and go on to our
58:36 PDF library and we have
58:40 um the gpants
58:43 um PDF that Dr LaRue just did and that
58:46 will give you actually all of the
58:47 accurate information I should have
58:49 printed those out and had them like at
58:51 my fingertips but go to the website
58:55 www.mygraincanada.org and Dr LaRue has
58:59 revised and just done the gpants
59:02 PDFs that will have preventative and
59:05 acute
59:06 and that will will help you out and you
59:08 can print it off and have it as a Bible
59:12 great thank you Wendy that’s it for now
59:15 okay and I know we’re overtime but I
59:18 think I only have a few more slides so
59:20 in summary guys like why do we need new
59:23 medications and devices to treat
59:25 migraines so first of all first in class
59:28 medications designed so actually
59:30 developed to treat migraine based on
59:33 scientific knowledge a lot of the
59:35 medications that have been prescribed to
59:37 you in the past have been like for
59:39 epilepsy or for seizures or for
59:41 depression so they weren’t designed they
59:43 just
59:44 they weren’t designed to treat migraine
59:46 they just they just worked but now we
59:49 have these medications who were actually
59:51 researched and developed to treat
59:54 migraines so that should be like a
59:56 no-brainer for anybody making these
59:58 decisions
01:00:01 um the the current options or the I
01:00:04 should say not the current but the past
01:00:05 options are just not sufficient they’re
01:00:08 like
01:00:09 um there there’s lack of Effectiveness
01:00:11 the side effects are horrible
01:00:13 um
01:00:14 they’re just they’re old they’re just
01:00:17 not designed to treat migraine
01:00:21 um and just adding on to that the dear
01:00:24 generation medications they have
01:00:26 pharmacological Advent advantages
01:00:30 again they’re designed to treat
01:00:31 migraines so they they have been
01:00:33 research researched and studied
01:00:37 um and lastly like migraine is disabling
01:00:39 and very costly to the healthcare system
01:00:41 to the individual to its Network to
01:00:45 Society at large and so
01:00:48 I don’t know like I I preached to the
01:00:50 choir
01:00:52 um or I guess I Don’t Preach at the
01:00:53 choir because
01:00:55 everything that we have to offer about
01:00:57 these new medications is
01:01:00 um there’s a no-brainer why they should
01:01:02 be offered
01:01:04 um I’m just really cognizant of time
01:01:06 guys
01:01:07 um so like what is migraine Canada doing
01:01:09 and what is our messaging so who do we
01:01:11 meet with I meet with the Ministers of
01:01:13 Health
01:01:14 I have ongoing Communications and
01:01:17 meetings with the various government
01:01:19 Ministries Deputy ministers and the drug
01:01:23 plans and then extending Outreach to
01:01:26 other Ministries so Finance women’s
01:01:29 issues
01:01:30 Ministers of employment all talking
01:01:34 about migraine and the impact in to each
01:01:37 respective Ministries
01:01:39 um and and what is our messaging so our
01:01:41 messaging is educational migraine to
01:01:44 eliminate stigma we need to narrow the
01:01:47 knowledge Gap and and that migraine is
01:01:49 just is more than just a headache more
01:01:53 than just a headache
01:01:54 um migraine is costly to society there’s
01:01:58 a significant burden on quality of life
01:02:00 we have our report
01:02:02 completed from the quality of life
01:02:04 survey now and we also have our report
01:02:07 card coming
01:02:08 imminently and within days
01:02:12 um we need access to effective taller
01:02:14 herbal safe medications there’s a need
01:02:17 for Choice Physicians and clinicians
01:02:20 need options they need more than one or
01:02:24 two options they need options to
01:02:26 everything that Health Canada has
01:02:28 approved
01:02:30 um
01:02:31 and really just emphasizing that what
01:02:34 many people are still using are old and
01:02:36 and they’re they’re not effective and
01:02:38 they have really nasty side effects and
01:02:42 we knew we need access to improve care
01:02:44 and we need access to healthcare
01:02:46 professionals to actually treat
01:02:47 migraines so that’s a little bit about
01:02:50 what we’re doing and what our messaging
01:02:52 is
01:02:55 um
01:02:55 and I’m getting to the end here so
01:02:57 leveraging our resources
01:03:00 um we have recently launched our
01:03:03 Canadian language guide which is really
01:03:06 the objective of that was really to get
01:03:09 people all kind of talking the same
01:03:11 language and you know
01:03:13 um what we hear from a lot of people and
01:03:16 this is internationally people living
01:03:18 with migraine don’t want to be referred
01:03:19 to as a sufferer but to somebody who
01:03:22 lives with migraine attacks so we’re
01:03:24 trying to adopt
01:03:26 um certain language practices that
01:03:28 hopefully will unfold across the various
01:03:33 um
01:03:34 um professions and and stakeholders who
01:03:37 are having the conversation about
01:03:39 migraine
01:03:40 um we recently launched our quality of
01:03:43 life survey report which is
01:03:45 um called the burden of migraine it’s
01:03:48 posted on our website
01:03:50 lots of great data thank you to
01:03:52 everybody who participated in the study
01:03:54 we had 1100 65 people participate 1144
01:03:58 from Canada
01:04:00 really good strong data so thank you for
01:04:04 everybody who participated and I
01:04:06 strongly encourage you to go and take a
01:04:08 look on the website I should have put
01:04:10 the links up here we also uh developed a
01:04:14 series of infographics on the various
01:04:16 topics on from that survey so thank you
01:04:20 thank you thank you thank you
01:04:22 um and the report card so we’re just
01:04:26 getting ready to launch the report card
01:04:28 and really what that is is it’s going to
01:04:30 give a snapshot to our government as to
01:04:34 what access to care and treatment looks
01:04:37 like for migraine in Canada and it
01:04:39 really gives
01:04:41 um a a very clear screenshot of where
01:04:46 the gaps are and with that comes
01:04:48 recommendations that we will be working
01:04:50 towards long term
01:04:52 to uh and measurable that we can measure
01:04:55 as we make progress
01:04:57 um
01:04:58 as to where the gaps are and what we’re
01:05:01 trying to get towards to make migraine
01:05:04 care in Canada be a priority and also
01:05:08 um support the community so
01:05:10 um watch for that guys that’s going to
01:05:12 be coming out very soon
01:05:14 um and then also just leveraging
01:05:16 Canadian voices so
01:05:18 um we really are looking forward to
01:05:21 recruiting ambassadors in each province
01:05:25 to sort of be our voice there like I I
01:05:29 like I said I I have meetings in every
01:05:31 province with various stakeholders I
01:05:34 would love to bring somebody to every
01:05:36 one of those meetings with me that lives
01:05:37 in that Province because you’re the
01:05:40 people who elected these guys in and so
01:05:43 your voice is bigger than mine when you
01:05:46 talk about it so if you’re interested in
01:05:49 and being a part of that will provide
01:05:51 training and support and that kind of
01:05:53 thing leading up to meetings I I want
01:05:55 you by my side because I can talk on
01:05:58 your behalf off but man when they hear
01:06:00 from you who voted them in or maybe
01:06:03 voted them out I don’t know but when
01:06:05 they hear from you living in said
01:06:07 province
01:06:09 that it’s huge so uh just
01:06:13 kind of talking about the resources I
01:06:15 probably left a few things out
01:06:17 I don’t have time I I wanted to dive a
01:06:19 little bit into a little bit of
01:06:21 self-advocacy but we don’t have time
01:06:22 tonight and maybe what I’ll do with
01:06:24 Kaylee is talk a little bit about
01:06:26 uh about the opportunity this fall to
01:06:29 hold
01:06:30 um a follow-up webinar where we talk
01:06:32 about self-advocacy and what you can do
01:06:34 how to do it because that it really is
01:06:37 in itself
01:06:39 um a webinar on its own and so I’m just
01:06:43 gonna kind of Pop through these
01:06:46 um and this is going to be oh I I can
01:06:49 actually go through and record what I
01:06:51 was going to say tonight on the actual
01:06:54 recording of the webinar
01:06:56 um
01:06:57 but like so just I’m just gonna take two
01:07:00 seconds so if your claim is rejected by
01:07:04 either provincial or a private
01:07:07 um
01:07:08 there’s lots of things you can do don’t
01:07:09 give up I’m telling you don’t give up
01:07:11 first of all make sure that your your
01:07:15 rights under the policy are in place
01:07:17 make sure that you have not made a claim
01:07:19 that is something for which you’re not
01:07:20 entitled to for example have you met the
01:07:23 criteria if you’ve not don’t even apply
01:07:25 for
01:07:27 um
01:07:28 don’t even apply it for reimbursement
01:07:31 make sure that you get through that in
01:07:34 criteria and your doctor will help you
01:07:35 to do that
01:07:37 um if you think you’re entitled
01:07:39 don’t let the first or even second
01:07:41 rejection stop you persistence is key
01:07:45 um
01:07:46 use use the appeals process that is in
01:07:50 place in your Province or with your
01:07:52 insurer and ensure that your position is
01:07:56 on board with you obviously if your
01:07:57 physician has prescribed you the
01:07:59 medication or your clinician
01:08:02 um
01:08:02 they’re they’re gonna kind of have your
01:08:04 back and want you to get it so just make
01:08:07 sure that all of the the necessary
01:08:09 documentation is completely filled out
01:08:13 you’ve met all of the criteria
01:08:16 you’ve checked every box double check
01:08:19 that kind of thing because sometimes
01:08:21 it’s just insufficient information that
01:08:23 is causing the rejection
01:08:25 um and sometimes doctors make an error
01:08:28 in the paperwork so they’re human they
01:08:30 have a lot on on the go and they they do
01:08:32 a lot of paperwork so it could just be
01:08:34 that there was sort of
01:08:36 um
01:08:37 that error and if it’s your employer who
01:08:40 has excluded the drug
01:08:42 again I want to do a whole webinar on
01:08:44 this but um
01:08:45 you know there’s a number of things that
01:08:48 you can do you can talk to your employer
01:08:51 um
01:08:52 talk about the the the the the the the
01:08:55 impact of the medication has on the
01:08:57 disease management
01:08:59 um
01:09:02 um ask your health benefits manager it’s
01:09:04 often your HR manager why they decided
01:09:07 not to cover the drug or discover or or
01:09:09 to cover drugs for migraine and again
01:09:14 it kind of feeds back into lack of
01:09:16 awareness of the impact of migraine in
01:09:18 the workplace
01:09:20 um
01:09:23 and and yeah so just kind of don’t give
01:09:26 up reach out to me I can kind of help
01:09:28 you along the way
01:09:30 um and so
01:09:34 yeah we’re like way over so what can you
01:09:36 do share your voice we do have a
01:09:40 seamless advocacy template on our on our
01:09:43 website where you just can go pick a
01:09:46 from a number of different template
01:09:48 letters related to what your situation
01:09:51 might be like
01:09:53 fire information off to your all you do
01:09:55 is type in your postal code your
01:09:57 minister of Health your Deputy minister
01:10:00 of health and your local elected
01:10:01 official will pop up
01:10:03 you just tailor the the
01:10:06 template letter a little bit and you hit
01:10:07 send and off it goes
01:10:10 um
01:10:11 I
01:10:13 I am always advocating for you and I I I
01:10:16 I
01:10:17 I’m I’m making progress I think I have
01:10:21 and I’m gaining attention but man you
01:10:24 guys are the best people to share your
01:10:27 voice and the more letters
01:10:29 and even if you sat down once a week and
01:10:32 fired a letter off to your elected local
01:10:34 official that person’s going to respond
01:10:37 to you and probably going to want to
01:10:39 have a meeting with you so you guys like
01:10:42 you guys are so powerful you don’t
01:10:44 believe how much power you have I
01:10:46 encourage you to just take the time and
01:10:50 email your your government about why we
01:10:54 need access to these new medications
01:10:56 because there hasn’t been any
01:10:59 um
01:11:00 and what else can you do so
01:11:02 if you’re not a member of migraine and
01:11:04 we don’t have members but if you’re not
01:11:05 a part of our community join us this is
01:11:08 how you do it migraincanada.org join and
01:11:11 again
01:11:12 share your voice through our advocacy
01:11:15 platform
01:11:16 um
01:11:18 the only thing you’re going to do is
01:11:20 help
01:11:21 and without is there any last questions
01:11:24 Kaylee I know it’s like really late I’m
01:11:26 sorry
01:11:28 just a couple
01:11:30 um would you have a guess as to why a
01:11:32 jovi and gallity and ammovig would be
01:11:34 covered by private insurance but not by
01:11:37 FD is it because it’s newer to Canada
01:11:40 probably yeah
01:11:42 yeah you have to remember that viapdi
01:11:44 has just was sort of the last cgrp to
01:11:47 enter the market so
01:11:49 um they’re gaining lots of traction the
01:11:52 other thing I don’t think I know I
01:11:55 mentioned guys is that to be really
01:11:57 important to have on your radar is in
01:12:00 the provinces of and I had it written
01:12:03 down
01:12:05 um
01:12:07 in provinces where the the major drug
01:12:12 the the major private insurers mimic
01:12:15 the um
01:12:18 the public drug plan so that’s like BC
01:12:21 Saskatchewan and Manitoba
01:12:24 um
01:12:25 they will not list a product until the
01:12:28 province has listed
01:12:30 so where we talk a little bit about BC
01:12:35 we need you guys to be like really
01:12:37 pumping your minister of health because
01:12:39 that is the public reimbursement is
01:12:43 flowing into BC pharmacare so
01:12:47 um
01:12:49 you’ll hear lots more from me on this
01:12:51 because it’s a huge issue and it BC is a
01:12:53 huge population
01:12:55 um and like it just creates complete
01:12:58 inequity of access
01:13:01 um to care
01:13:03 thank you Monday and finally just a
01:13:07 suggestion here I think this person was
01:13:08 quoting what you had said earlier
01:13:11 um quoting need for access to effective
01:13:13 tolerable and safe medications we want
01:13:16 to add affordable to this messaging as
01:13:19 well so that it’s effective tolerable
01:13:21 affordable and safe yeah
01:13:25 yeah I mean with any new Innovative
01:13:29 medications there comes a price right
01:13:31 like
01:13:33 um and I and I take my pharmaceutical
01:13:35 hat off because that’s where I came from
01:13:37 for a long time but it costs a lot of
01:13:39 money to bring these medications to
01:13:41 Market and so
01:13:43 um I can assure you
01:13:45 from what I know
01:13:48 the manuf the manufacturers have really
01:13:51 done a good job negotiating price like
01:13:53 if I compare
01:13:56 um the cost of migraine medications
01:13:59 which is you know several hundred
01:14:02 dollars say 500 600 a month to
01:14:05 [Music]
01:14:08 um medications to treat arthritis which
01:14:11 are like
01:14:12 thousands of dollars a month
01:14:15 this is a no-brainer and I think it
01:14:16 falls back to this is me personally
01:14:19 speaking
01:14:20 is there a little bit of stigma like oh
01:14:22 like why we have to pay so much for my
01:14:24 like for headache treatment
01:14:26 um which leads into the importance of
01:14:29 all of the advocacy and the education
01:14:31 that we’re doing to say like but these
01:14:34 this little few hundred dollars is
01:14:38 putting people back in the workplace
01:14:41 you know
01:14:42 um and again I go back to BC
01:14:45 um I have handfuls of nurses who are on
01:14:49 disability and or have left the
01:14:51 workforce for early retirement because
01:14:53 of their migraines and we’re in a
01:14:55 healthcare professional shortage like
01:14:57 we’re short nurses
01:14:58 but these people would love nothing more
01:15:00 than to be working and so this makes no
01:15:04 different like so this is a non-brainer
01:15:07 to me cover the medications get these
01:15:10 people back working helping out the
01:15:12 Health Care system and it’s not just
01:15:13 that it’s teachers it’s like it just on
01:15:17 it’s not like any profession specific it
01:15:21 can be filtered over into lots of
01:15:24 professions I’m sure there’s lots of
01:15:26 police officers who are on disability
01:15:29 because they you know their migraines
01:15:32 are impacting their life and they don’t
01:15:34 have access
01:15:36 um
01:15:37 I I think I’m going off on a rant but
01:15:39 um
01:15:42 yeah like it the the price for these
01:15:45 medications for the pair is not
01:15:48 significant compared to other
01:15:51 treatment options and Dr LaRue would say
01:15:53 like you know if you compare it to a
01:15:55 treatment option for Ms or epilepsy
01:15:59 which is like fifty thousand dollars a
01:16:01 year for one treatment
01:16:03 like we’re talking five hundred dollars
01:16:05 six hundred dollars
01:16:07 I don’t know
01:16:10 thank you Wendy for all of that
01:16:13 information you crammed in as much as
01:16:15 you could thank you I hope I didn’t
01:16:17 overshare
01:16:18 and just a reminder everyone if we
01:16:21 didn’t fully answer your question if you
01:16:23 have more questions contact us at info
01:16:27 migraincana.org and Wendy has provided
01:16:30 her personal email address as well
01:16:31 executive director at
01:16:33 migrainecanada.org check out our events
01:16:36 page for the rest of our fall webinar
01:16:37 series follow us on our social join our
01:16:41 community and Healthcare professionals
01:16:43 you can request a participation
01:16:45 certificate and with that uh have a
01:16:48 great evening everyone and thank you for
01:16:50 joining us
01:16:54 [Music]