Inclusion of drugs in provincial drug benefit programs: who is making these decisions, and are they the right ones?

Over 2 years ago, I joined the Drug Quality and Therapeutics Committee (Therapeutics Committee) of the Ontario Ministry of Health and Long-Term Care. Using mainly cost-effectiveness criteria, the committee suggests to the minister which drugs should be included in the drug benefit program for Ontario residents over the age of 65 years and those on social assistance.

Given that resources for healthcare are limited, it seems sensible to me that cost-effectiveness is the main criterion used to determine which drugs are reimbursed from the public purse. However, some physicians believe that the Therapeutics Committee unreasonably increases the bureaucracy associated with patient care and restricts their ability to prescribe useful medications. In addition, many in the pharmaceutical industry view the committee as having a predominantly cost-containment agenda, and members of the public have complained that the Therapeutics Committee deliberates in private and that patients have no input into the process.

In this essay, I describe the organization of the Therapeutics Committee, the annual budget of the Ontario Drug Benefits Program and the major drugs the program funds. I also provide some thoughts about the Therapeutics Committee, in particular, and about the use of information concerning the cost-effectiveness of drugs in general.