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A possible deathblow to CAMR

The Senate Committee on Banking, Trade and Commerce met again today on the subject of Bill S-232, amending the Canadian Access to Medicines Regime. They heard from two witnesses today – Glen Shepherd, President and CEO of Health Partners International of Canada, and Amir Attaran, Associate Professor in the Faculties of Law and Medicine at the University of Ottawa.

As the head of a group that coordinates distribution of drugs donated by both brand name and generic pharmaceutical companies, Shepherd had little opinion to offer on the substance of CAMR, but did want to make a plea for the restoration of the Medical Aid Tax Incentive, which the government has currently suspended. What Shepherd largely offered to the committee were some of his experiences with regards to the issue of diversion – medicines that are destined for a needy developing country somehow winding up in other places, like Eastern Europe, thanks to the black market or what have you.

In Shepherd’s experience, there have been one, possibly two recorded cases of diversion happening in the twenty years that his organisation has been operating. The pharmaceutical companies themselves handle much of the monitoring, and they are pretty vigilant. Given that diversion is often raised in the context of problems with CAMR, this experience puts those fears to rest.

But it was the second witness, Professor Attaran, who drove a stake through the bill’s heart.

It is in his estimation that the fixes to CAMR won’t work – that even when all the changes are made, nothing will happen. Attaran charges that CAMR has failed for economic reasons – because Canada has among the highest generic drug costs in the world, there’s been no cause to take up meds from this country, as they can be had for cheaper elsewhere. After all, the fixes the bill proposes already exists in places like the EU, and yet they have not had any uptake in their similar legislation.

Attaran says that we would be better off spending our legislative time and energy on fixing CIDA’s budget, or stopping our asbestos exports, as they would have a much more measurable impact on the health of the world populations.

And while Attaran has these points, didn’t Apotex already say that if the changes were made, they would employ CAMR again? That seems to me to be a signal that it wouldn’t fail. Apotex also said that the changes proposed would also allow them to become more competitive because their contracts could be expand to allow for economies of scale, and thus becoming more competitive? After all, they did compete on price with the drug they shipped to Rwanda. So perhaps CAMR won’t be such a failure for the same economic reasons that Attaran cites.
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