Backgrounder

Canadians for Equitable Access to Depression Medication (CEADM)

In an unprecedented move, mental health professionals and leaders, advocates, doctors, academics and people with lived experience from across the country have joined together to form a coalition to ensure equitable and sustainable access for all Canadians suffering with depression.

Through Canadians for Equitable Access to Depression Medication (CEADM), these coalition members are speaking with a common voice on behalf of Canadians who need equitable access to medication to treat their depression, regardless of their income, education or access to employment benefits.

CEADM’s objectives are to:

  • create awareness among policy-­‐makers about the complexity of major depressive disorde and the effects of depression on Canadians’ overall health;
  • highlight the inequity/fairness issue for many Canadians who rely on a public drug plan approval system that requires fixing; and
  • make depression care a priority among policy-­‐makers.

The Issue Around Inequity and the Public Drug Plan System

At the heart of the problem, preventing vulnerable Canadians from accessing the latest medicines, are three related issues.

Number 1: Depression is complex, with 227 different combinations of symptoms. There is no ‘one-­‐size-­‐ fits-­‐all’ approach to treatment. A wide choice of therapy is critical to be able to find the best option for individual patients when it comes to treating mental illness — one that addresses not only mood but also changes in sleep patterns and appetite, as well as cognition.

Number 2: Canadians who depend on public drug coverage because of a lack of income, education or access to employment benefits are limited to a range of drugs that are available to treat depression. Currently, public drug plans only cover medications that were developed to address mood symptoms However, as we learn and understand more about depression, it is clear that a broader range of choice of medications brings with it a greater probability of success. Unfortunately, that broader range of choice of medications is not available to those on public drug plans.

Number 3: Despite the fact that innovative medications have been approved as safe and effective treatments by Health Canada, a complex multi-­‐stage review process is preventing these medications from being approved for public drug plan coverage.

Under the current system, new drugs are submitted to a health technology assessment (HTA) agency for evaluation. While it is not the only element that is evaluated, the cost of a medication does play a significant role in the decision-­‐making process, even though HTA evaluations are meant to be evidence-­‐ based, where clinical effectiveness and safety are also considered. The Canadian Agency for Drugs and Technologies in Health (CADTH) then releases its final recommendations to the federal and provincial/territorial governments.

Of the 21 new mental health drug submissions filed to the CADTH between 2004 and 2015:

  • 2% were given negative recommendations for public drug plancoverage.
  • 100% of the submissions for major depressive disorder received a negative recommendation— not listed for reimbursement — while of the 134 non-­‐mental health drug submissions, 65 (48.5%) received a negative recommendation.
  • The review process was considerably lengthier, at 242 days on average for mental health drugs compared to 192 days for non-­‐mental health drugs.
  • It is estimated that the direct costs of new mental health drugs on provincial, territorial and the federal Non-­‐Insured Health Benefits (NIHB) public drug plans represents less than 1 percent of the more than $54 billion in societal costs associated with the economic burden of mental illness in Canada.

Furthermore:

  • Public drug plan spending on the direct costs of new mental health drugs was less than 1% of the more than $54.6 billion associated with the total economic burden of mental illness in Canada for 205.

Members of Canadians for Equitable Access to Depression Medication to date:

  • Phil Upshall, National Leadership Team, Mood DisordersSociety of Canada
  • Dr. Patrick Smith, National Leadership Team, Canadian Mental Health Association
  • Jeff Moat, National Leadership Team, Partners for Mental Health
  • Ann Marie MacDonald, Regional Ontario Co-­‐Chair; Mood Disorders Association of Ontario
  • Michael Landsberg, Regional Ontario Co-­‐Chair; #SickNotWeak
  • Laureen MacNeil, Regional Alberta Co-­‐Chair; Canadian Mental Health Association, Calgary
  • Ron Campbell, Regional Alberta Co-­‐Chair; person with lived experience
  • Dave Grauwiler, Canadian Mental Health Association, Alberta
  • Camille Quenneville, Canadian Mental Health Association, Ontario
  • Dr. Sid Kennedy, University Health Network
  • Pratap Chokka, Chokka Centre for Integrative Health
  • Bill Gaudette, formerly CMHA, Past Member, Provincial Mental Health Board (Alberta)
  • Brianne Moore, person with lived experience, Ontario
  • Jean-­‐François Claude, person with lived experience, Ontario