Most pharmaceutical expenditure in Canada is private. In 2017, Canadian provincial, territorial and federal governments were reported to have spent $14.5 billion on pharmaceuticals, accounting for only 43% of total pharmaceutical expenditure.1 A combination of private insurance and patient expenditures in the form of direct payment for pharmaceuticals, deductibles and other forms of co-insurance payments among those privately or publicly insured makes up the remaining 57%.2 Whereas much of the conversation around increasing pharmaceutical costs has focused on the substantial growth within public budgets, little attention has been paid to how the various approaches to pricing negotiation may affect patients. We discuss the complicated landscape of drug pricing in Canada and highlight the variable impact on patients’ drug expenditures of the 2 most common practices within pharmaceutical pricing, confidential pricing and rebates, to help inform policy decisions.
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Aidan Hollis, Braden Manns, Fiona Clement, K. Ally Memedovich, Reed Beall