Time to Fix Canada’s Public Drug Plan System; Time to Ensure Equitable and Sustainable Access for All Canadians Suffering with Depression

Submitted by Phil Upshall, Executive Director, Mood Disorders Society of Canada; Dr. Patrick Smith, CEO, Canadian Mental Health Association; and Jeff Moat, President, Partners for Mental Health

It’s alarming enough that one in five Canadians suffers from mental illness, including major depression, but Canadians aren’t alone. Depression is the leading cause of disability worldwide, with more than 350 million people affected.

During this year’s Mental Health Week from May 1–7 — launched in 1951 by the Canadian Mental Health Association — Canadians from all walks of life are getting loud for mental health, including mental health leaders and advocates from across the country. In an unprecedented move, they have come together as a coalition to make positive change happen around equitable and sustainable access for Canadians suffering with depression.

Canadians for Equitable Access to Depression Medication’s (CEADM) aim is threefold: create awareness among policy-makers about the complexity of major depressive disorder 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.

Here in Canada, in 2017, the federal and provincial/territorial governments have yet to develop a coordinated mental health strategy to tackle the growing mental health challenge, where the economic and social burden is estimated at $51 billion a year. Current figures by Statistics Canada indicate that over 7 million Canadians have a mental illness and that 4,000 people die by suicide every year, including about 1,000 children.

Yet, of Canada’s $187.51/person total investment into health care overall (2011 dollars), a mere $5.22/person represents the mental health care portion. Compare this to three other OECD countries: $62.22/person in the United Kingdom; $98.13/person in Australia; and $198.93/person in New Zealand.

But beyond this poor investment record is a huge access issue that affects the ability of the most vulnerable segments in our society — the marginalized, the unemployed, single parents, veterans, seniors, people on low incomes, Indigenous peoples — to receive a broad range of choice in depression medications. Unlike those who benefit from private drug plan coverage, these vulnerable citizens only have access to a limited range of depression medications, largely those developed to address mood symptoms.

Depression is a complex illness, with a staggering 227 combinations of symptoms that affect one’s emotional, cognitive and physical health. A broader range of choice of medications addresses all three facets, bringing with them a greater probability of recovery. If those choices aren’t available to those who rely on the public drug plan system, then the chances of successful treatment are considerably slimmer.

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. Here’s how it works. 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, 76.2% were given negative recommendations for public drug plan coverage. Of particular interest is the fact that all of the drugs used to treat depression were rejected. Compare this to the 134 non-mental health drug submissions, where almost half were approved (48.5%). The review process was also considerably lengthier, at 242 days for mental health drugs versus 192 for non-mental health drugs.

According to Kimberley Tran, Nigel Rawson and Brett Skinner, who authored “HTA Decisions and Access to Mental Health Treatments in Canada’s Public Drug Plans,” which was published in February of this year in Canadian Health Policy: “Despite the importance to patients of having access to a wide range of treatment options, research has suggested that access to new medicines in Canada’s public drug plans is lagging when compared to access in private sector drug plans, and when compared to public drug plans in other countries.”

Over the past half century, we’ve made great strides in developing innovative depression treatments. But they shouldn’t be available to only those with private health plans. Now’s the time to advance this country’s public drug plan system so all Canadians can benefit.

Improving the mental health of millions of Canadians who have major depressive disorder shouldn’t be an employment lottery, where only a select few have timely access to a broad range of medications to treat such a complex illness. CEADM is calling on the federal and provincial/territorial governments to right this wrong.

Making sure that all Canadians have access to all depression medications will go a long way to addressing what is the most significant public health issue of the 21st century.

Canadians for Equitable Access to Depression Medication is a Canada-wide organization that speaks 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.