The reimbursement landscape in Canada is a complex and evolving one. Cost-containment imperatives are driving increasingly robust review processes for drug therapies by both public and private payers. As a result, it is more critical than ever that Reimbursement Submissions are well-crafted, professionally managed and strategically supported by evidence, Stakeholder Relations, Advocacy and comprehensive Government Relations.
 
Depending on the individual client’s Market Access Strategy for a given therapy and their own in-house capacity, The JBL Group can quarterback a winning Reimbursement Submission targeted at multiple levels, including: 

 

• National / Federal level (e.g. ,Common Drug Review (CDR), pCODR, NIHB);
• Provincial Formularies (e.g. individual provincial drug plans, including INESSS in Quebec and the new Pan-Canadian Pricing Alliance – PCPA);
• Private Payers; and
• Hospitals.

CDR Submissions



The largest and most complex reimbursement submission is to the CDR. Submissions are required for Public Payer reimbursement in Canada of any New Chemical Entity (NCE), as well as any new indications for existing drugs. CDR submissions encompass all Provincial Formularies (except Quebec), as well as federal Payer programs. 



Provincial Formulary Submissions



Consultants at The JBL Group have led more than 200 individual Submissions to provincial formularies. Although the components of these submissions are similar to CDR Submissions, the strategy and tactics that lead to successful reimbursement vary greatly, depending on the drug and the policy environment in each specific province. In addition, The JBL Group has expertise in preparing successful Provincial Submissions for pharmaceutical products that are not considered a New Chemical Entity (e.g. line extensions, old chemical entities and formulation changes). 
 
Pan Canadian Pricing Alliance (PCPA)
 
The JBL Group is also on the leading-edge, handling a number of cases under the new, evolving PCPA process and has negotiated numerous Provincial Listing Agreements (PLAs).

 Quebec



Submissions to the Quebec Liste de medicament, in, present their own unique challenges. As well, Submission requirements have been recently updated. Our Consultants are very familiar with these new requirements and The JBL Group is uniquely positioned to liaise with the Institut national d’excellence en santé et services sociaux (INESSS) on behalf of our clients. 



Private Payer Submissions



Private Payer insurance pays for approximately 45% of all drug purchases in Canada. Any new pharmaceutical product in Canada, whether a NCE or not, must file Submissions to Private Payers in order to be considered for reimbursement. The Private Payer community is diverse and includes Insurance Companies, Pharmacy Benefit Managers and Health Benefit Consultants. The JBL Group is familiar with these companies and has experience crafting successful Reimbursement Submissions for each of these unique stakeholders. 



Hospital Submissions



Often overlooked by many companies, Hospital Submissions are another important element to a successful Reimbursement strategy. Each hospital in Canada has a Therapeutics Committee (P&T) that evaluates information on new products intended for use in a hospital setting. The JBL Group can provide all the components necessary to support the creation of winning Hospital Submissions.