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Source: ForeignAffairs4

Source: The Conversation – Canada – By Joel Lexchin, Professor Emeritus of Health Policy and Management, York University, Canada

Drug pricing in Canada just got more industry-friendly.

Canadian drug prices are already the fourth highest in the industrialized world. Now, with the release of new guidelines for the staff at the Patented Medicine Prices Review Board (PMPRB) at the end of June, the situation is poised to potentially get even worse.

The review board is the federal agency that was set up 1987 to ensure that the prices for patented drugs are not “excessive.”

Comparing prices

Up until now, one of the criteria the PMPRB used in making the decision about what was an excessive price was to compare the proposed Canadian price for a new drug with the median price in 11 other countries. The median is the 50 per cent mark; in other words, the price in half of the other countries was below what’s proposed for Canada, and the price in the other half was above the proposed Canadian price. Under the new guidelines, set to take effect on Jan. 1, 2026, the Canadian price can be up to the highest in those other 11 countries.

Right now, the median price in the 11 countries Canada is compared to is 15 per cent below the price of patented drugs in Canada. The highest international price, which will be the new standard, is 21 per cent above the median Canadian price, meaning Canadian prices for new drugs will be significantly higher than they otherwise would have been.

Sometimes a drug is not available in any of the 11 other countries when it comes onto the Canadian market. In that case, the company can price the drug at whatever level it wants and keep it at that price until it comes up for its annual price review. The executive director of the PMPRB told the Globe and Mail that this would incentivize drugmakers to bring their products to the Canadian market first.

Incentivizing drug companies may be a reasonable idea, but that’s not part of the mandate of the PMPRB. As laid out in Section 83 of the Patent Act, its mandate is to ensure drug prices aren’t excessive.

Additional therapeutic value

In the past, one of the factors that the PMPRB took into account in determining if prices were excessive was the additional therapeutic value of a new drug compared to what was already on the market. The lower the value, the lower the price. In this regard, the PMPRB was advised by its Human Drug Advisory Panel, an independent group of experts.

The ranking of new drugs against existing ones was also of significant value to Canadian clinicians. It helped them to decide on the best treatment option for their patients and countered the hype about new drugs that came from the manufacturers.

Since the new guidelines have abandoned looking at therapeutic improvement of new drugs, that leaves only one remaining Canadian source for that type of information, the Therapeutics Letter, a bimonthly publication targeting identified problematic therapeutic issues in a brief, simple and practical manner.

Complaints about prices can be made by federal, provincial and territorial health ministers and by senior officials who are authorized to represent Canadian publicly funded drug programs. “Other parties who have concerns about the list prices … are encouraged to raise their concerns with their relevant Minister(s) of Health or Canadian publicly-funded drug program (sic).” This advice is cold comfort for people working low-wage jobs who aren’t covered by provincial and territorial drug plans and don’t have any access to their health minister.

If there is an in-depth review of a new drug’s pricing — a preparatory step to determine whether there should be a formal hearing to investigate if the price is excessive — it is only the manufacturer that is allowed to submit information to the PMPRB. Clinicians who prescribe the drug, patients who take the drug, and organizations and individuals that pay for the drug do not have that same right.

Donald Trump’s on-again, off-again tariffs are already threatening to drive up drug prices and make prescription drugs inaccessible to many Canadians. Higher drug prices will also almost certainly affect Canada’s already limited pharmacare program. Higher prices for new drugs will make an expanded pharmacare plan more expensive and less appealing to the federal government. The new PMPRB guidelines help ensure higher drug prices and no pharmacare expansion.

Between 2022-2025, Joel Lexchin received payments for writing a brief for a legal firm on the role of promotion in generating prescriptions for opioids, for being on a panel about pharmacare and for co-writing an article for a peer-reviewed medical journal on semaglutide. He is a member of the Boards of Canadian Doctors for Medicare and the Canadian Health Coalition. He receives royalties from University of Toronto Press and James Lorimer & Co. Ltd. for books he has written. He has received funding from the Canadian Institutes of Health Research in the past.

– ref. Canada’s new drug pricing guidelines are industry friendly – https://theconversation.com/canadas-new-drug-pricing-guidelines-are-industry-friendly-261062

Source: ForeignAffairs4

Source: The Conversation – Canada – By Kevin Kriese, Senior Wildfire and Land Use Analyst, Centre for Global Studies, University of Victoria

As the summer heat intensifies, people across Canada are facing the full brunt of wildfire season. Communities are being evacuated and properties are being destroyed as fires grow in size.

Over the past decade, wildfires in Canada have broken numerous records, including the area burned in the largest single fire in recent history.

More frequent fires are unsettling communities, causing rapid changes to ecosystems and having a negative impact on society and our economy.

Increased wildfire risk is driven by a variety of factors, including more extreme fire weather (high temperatures, low humidity and powerful winds) made worse by climate change, fire deficits, the accumulation of fuels like trees and other organic materials on the landscape and changing land-use and settlement patterns.

Our new research from the POLIS Wildfire Resilience Project at the University of Victoria explores how beneficial fires — fire that maximizes ecological benefits and minimizes risks to communities — can help build wildfire resilience.

What are beneficial fires?

Fire is a natural, necessary and inevitable part of many ecosystems in Canada. Historically, wildfire created a mosaic of diverse ecosystems and habitat conditions, which supported healthy watersheds and contributed to the cultures and livelihoods of Indigenous Peoples.

Beneficial fire typically includes Indigenous cultural burning, prescribed fire and managed wildfire. These fires are managed for their ecological, cultural and community benefits, while minimizing adverse effects.

One reason we’re seeing more catastrophic fires now is because of a history of widespread wildfire suppression, which can allow fuels to accumulate. When fuels accumulate, the risk from wildfire increases.

In certain places and contexts, suppression remains the appropriate approach. It will continue to play a critical role in keeping communities safe and conserving ecosystem services like clean water and special places. But suppression alone is not viable or desirable. Instead, a suite of proactive actions from a variety of stakeholders is required.

In British Columbia, Indigenous communities are returning cultural burning to their territories. A burn by the ʔaq̓am First Nation, with support from the BC Wildfire Service and local fire departments, was credited with helping save lives and homes from the St. Mary’s wildfire in summer 2024.

Later in 2024, portions of a wildfire near the Wet’suwet’en community of Witset were allowed to burn while firefighting efforts focused on the part of the fire that threatened the community. This approach protected the village of Witset while still allowing the fire to create ecological benefits.

Despite increasing awareness that some fires are beneficial, community opposition to cultural and prescribed fires — as well as to letting wildfires burn — persists. This opposition stems from a longstanding fears of fire and the very real threats posed to communities, people and property.

A whole-of-society approach

Until people feel safe from wildfire, the ability to return fire to the landscape will be limited and pressure for maximum suppression will likely continue. However, when people feel safe in their homes and communities, they may be more likely to accept more beneficial fire on the landscape.

Risk reduction programs, such as FireSmart, take a holistic approach to wildfire resilience and include practical measures proven to reduce property loss.

Homeowners who live near fire-prone ecosystems (referred to as the wildland-urban interface) can take simple actions, such as removing flammable material within 1.5 metres of buildings, while communities can plan effective evacuation routes.

Experience in other jurisdictions indicates that voluntary measures, like FireSmart, are more effective when combined with mandatory minimum standards for fire-resistant building construction, vegetation management and landscaping.

Reducing risk and increasing beneficial fires requires co-ordinated action from a diverse array of parties. For example, creating home-hardening requirements demands updated provincial building codes and local government plans that consider wildfire resilience.

When a diverse array of entities is required to work towards a common goal, co-ordination and collaboration are vital and a whole-of-society approach is required. This type of approach fosters innovation, local agency and broader accountability — ultimately resulting in better outcomes on the ground.

There are calls for this approach at national and international levels. Recent examples include the Canadian Council of Forest Ministers’ Canadian Wildland Fire Prevention and Mitigation Strategy and the G7 Kananaskis Wildfire Charter.

Diverse actions needed

Crown governments have historically worked in a top-down wildfire management model: provincial and territorial governments are in charge and select partners, such as industry, have been engaged to carry out specific actions.

We are beginning to see a shift to greater sharing of responsibilities, partnerships, recognition of Indigenous authorities and increased local action. For example, B.C. has committed to “integrate traditional practices and cultural uses of fire into wildfire prevention and land management practices and support the reintroduction of strategized burning.”

As Canadians face another intense wildfire season, in which we’ve already experienced loss of life and property, meaningful action across all of society is essential.

Provincial governments must work in collaboration with Indigenous, local and federal governments, as well as industry, civil society, practitioners, local experts and communities.

Individuals can take action to reduce the risk to their homes by managing the vegetation around their homes and using more fire-resistant building materials. Communities can engage in risk reduction and resilience planning. And governments at all levels can facilitate changes in how we manage our landscape to increase beneficial fires.

Taken together, these diverse actions across all of society will be crucial for protecting people and ecosystems as we all learn to live with fire.

Kevin Kriese is a member of the Liberal Party of Canada.

Andrea Barnett receives funding from the Gordon and Betty Moore Foundation.

Oliver Brandes receives funding from Gordon and Betty Moore Foundation and the BC Real Estate Foundation.

– ref. Dealing with wildfires requires a whole-of-society approach – https://theconversation.com/dealing-with-wildfires-requires-a-whole-of-society-approach-260568