Internal emails from the agency tasked with regulating the price of patented drugs in Canada shows discord and division was sparked by a letter from the health minister, culminating in an indefinite pause on major drug-price reforms and several resignations.
Emails released to the House of Commons committee on health suggest some on the regulator’s board believed the crisis that followed the minister’s letter threatened the very survival of the agency.
“We are experiencing a significant conflict that must be resolved to ensure the survival, integrity and proposer conduct of business for the (Patented Medicine Prices Review Board),” former acting chair Melanie Bourassa Forcier wrote to the board members on Dec. 4, 2022.
She resigned from her post the next day.
The emails show the conflict began last November, when the Patented Medicine Prices Review Board was in the process of consulting on the finer points of recently adopted rules that would drastically change how drug prices are set in Canada.
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Innovative Medicines Canada, a pharmaceutical lobby group, requested a meeting to talk about its concerns on Nov. 18.
Ten days later, Health Minister Jean-Yves Duclos wrote to the acting chair and suggested the process be paused to give drug companies, patient groups, provincial ministers and himself more time to understand the changes.
“I respectfully ask that the board consider pausing the consultation process, so as to work collaboratively, with all stakeholders, to understand fully the short and long-term impacts of the proposed new guidelines,” Duclos wrote.
The letter was received with surprise by the arm’s-length agency, which until that point had thought the minister was on board with its plan, and kicked off an intense 10-day-long argument that ended in the suspension of the new rules.
While the acting chair of the review board wanted to acquiesce to Duclos’s request and meet with the pharmaceutical lobby group before the consultation period ended, the rest of the board and the executive director, Douglas Clark, protested.
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Clark told Bourassa Forcier they should not engage with the minister.
“In fact, we should be trying to respectfully communicate that what he is ‘requesting’ is highly problematic,” he said in an email on Nov. 30.
Clark also insisted that the minister had no intention of meeting with the board or the acting chair.
“The most important thing right now is to protect ourselves. The minister doesn’t want anything to do with us,” Clark said in a text exchange with Bourassa Forcier.
“They want us to go away and the members to resign of their own accord, since they can’t fire them.”
Duclos has repeatedly denied putting any undue pressure on the review board.
Bourassa Forcier’s response to Duclos didn’t include any commitment to pause the consultation period, but she did tell the deputy Health minister that she was open to the idea and would discuss it with the board.
“Making such a promise puts us three in a terrible position because if we don’t suspend as she intends, the (deputy minister) likely suspects/knows it’s us holding that up,” board member Matthew Herder told his fellow board members in an email on Dec. 2.
He said he was “completely dismayed.”
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Herder and the other two board members took a hard stance against the minister’s request, insisting that the consultations end on time and that the board meet with Innovative Medicines Canada after that.
Bourassa Forcier said that would be morally and professionally impossible for her, and explained that to extend the consultation or meet with the lobby group beforehand wouldn’t cost them anything. She ended her response on Dec. 1 with a warning:
“If the minister decides to get rid of the PMPRB we will not achieve our objectives,” she wrote to the board.
Clark rebuked the acting chair, having had a “harsh” conversation with the lobby group just weeks earlier.
“If the board decides to suspend consultations and make a public announcement to that effect, staff members will lose credibility with (Innovative Medicines Canada), and any future meetings between us will be window dressing at best, as IMC will know that if it hears anything it doesn’t like, the minister will order the board to back off,” he wrote.
The situation devolved from there.
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Bourassa Forcier said she was not comfortable refusing the minister’s request and couldn’t understand why the board was so reluctant to extend the consultations.
She later told the health committee she did not feel pressured by Duclos’s letter and agreed the agency should take more time to consult on the proposed change.
The parties traded accusations about personal attacks, insubordination and negative effects on their mental health.
“I have never seen the head of an organization demonstrate such a lack of judgment and engage in such questionable ethical behaviour in so short a time,” Clark wrote.
On Dec. 5, the day the consultation period was set to close, Bourassa Forcier said remaining silent sent a message of confrontation she was not comfortable with.
“I am sincerely effected by the scale of the crisis, all of this because I expressed my interpretation of our obligation to consult,” she wrote.
She resigned later that day.
The rule changes, which would have come into effect on Jan. 1, were put off indefinitely. Clark and Harder announced their own resignations in February.