Reimbursement Submissions

In the current Canadian environment there are four (4) basic types of reimbursement submissions pharmaceutical companies must consider.  The largest and most complex reimbursement submission is prepared for the Common Drug Review (CDR).  These submissions are required for the reimbursement of any new chemical entity (NCE) by public payers. Recently the CDR decided to also review new indications for old drugs. CDR submissions encompass all Provincial Formularies (excluding Quebec) as well as federal payer programs.

The second  type is the Provincial Formulary submission.  The Consultants at The JBL Group have performed more than 200 individual submissions to provincial formularies.  Although many of the components of these submissions are similar to CDR submissions, they can differ in strategy and they must focus on specific provinces where the manufacturer seeks  reimbursement.  Any pharmaceutical product that is not considered a new chemical entity (line extensions, old chemical entities and formulation changes).

Submissions to the Liste de médicament, in Quebec present their own unique challenges.  In 2007, the requirements for these submissions were updated.  Our Consultants are very familiar with the new requirements and are uniquely positioned to interact with the Conseil du médicament in these matters.

The private payer market in Canada pays for approximately 45% of all drug purchases.  The private payer community is diverse and consists of Insurance Companies, Pharmacy Benefit Managers, and Health Benefit Consultants.  The JBL Group is experienced in crafting reimbursement submissions for each of these unique stakeholders.  Any new pharmaceutical product in Canada, be it a new chemical entity or not, that is seeking reimbursement from the private payers sector must file submissions to this group .

The fourth reimbursement submission is one that is often missed by many companies. The Hospital Submission.  Each individual hospital in Canada has a Pharmacy and Therapeutics Committee (P&T) that evaluates information on new products that are to be used in a hospital setting.  We can provide all the appropriate components of hospital submissions.

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