Solving complex reimbursement, 
pricing and health policy issues across Canada

The JBL Group brings expert knowledge and an in-depth understanding of Canadian health policy, at the federal and provincial levels. Our seasoned professionals constantly monitor this ever-changing policy environment. 

We offer our clients a unique, insider's perspective and can assess the impact that policy changes can have on their businesses. The seasoned professionals at The JBL Group can develop tailor-made strategies to influence public policy, to meet our clients’ strategic objectives.
 
The JBL Group can help to create customized action-plans to change public policy, by:
 

• Conducting policy impact assessments
• Organizing support
• Obtaining consensus
• Lobbying Government

The Consultants at The JBL Group have unique, inside-knowledge of government processes and relationships with key decision-makers and influencers and - most importantly - experience leveraging these advantages to negotiate product Reimbursement and achieve Policy change, on behalf of our clients.  
 
The JBL Group provides a strategic and integrated approach to Government Relations.  Our consultants have access to cross-Canada network of key contacts within the bureaucracy and at the political level.  The JBL Group has in-depth knowledge of decision-making processes and related networks of influence, knowing who to lobby and when.

 Many pharmaceutical manufacturers in Canada think of Government Relations as dealing only with the Federal Government and its various branches, such as Health Canada and the Patented Medicine Prices Review Board.

While The JBL Group consultants are experienced in dealing with the Federal Government, we find that a great deal of our time is expended in Government Relations with provincial governments.

 Successful Reimbursement Strategies often depend on the ability to discuss issues and negotiate with members of the provincial government. Although significant time is spent discussing these matters with bureaucrats in the various provincial Ministries of Health, it is frequently necessary to involve other Ministries such as Economic Development and Trade, to obtain a successful outcome. The Consultants at The JBL Group have a great deal of experience working with all levels of provincial governments to successfully negotiate product Reimbursement and Policy change. Our Consultants are also skilled in issues management, communication and negotiation – and actively leverage all of these tools to achieve winning results on behalf of our clients. 

Most pharmaceutical manufacturers in Canada invest a great deal of time and resources developing Marketing Plans for products they plan to launch in the next 2 - 5 years. However, many companies fail to include Market Access Strategies in their planning processes. It is important to understand that the marketplace at time of launch may differ significantly from what it is today. The Consultants at The JBL Group have a great deal of experience in forecasting change in the marketplace and in developing Market Access Strategic Plans to assist our clients with Pricing and Reimbursement Strategies. We can also support clients during the implementation phase of these plans.

At The JBL Group we help clients take a step back from tactics and carefully plan a coherent strategy, based on business objectives to:
 

• Define the problem and desired outcome
• Explore all possible alternatives and consequences
• Chart a course that makes sense
• Determine optimal product pricing
• Build a solid business case to convince payers of value of reimbursement
• Prepare winning submissions for private and public payers
• Implement and execute successfully

The reimbursement landscape in Canada is a complex and evolving one. Cost-containment imperatives are driving increasingly robust review processes for drug therapies by both public and private payers. As a result, it is more critical than ever that Reimbursement Submissions are well-crafted, professionally managed and strategically supported by evidence, Stakeholder Relations, Advocacy and comprehensive Government Relations.
 
Depending on the individual client’s Market Access Strategy for a given therapy and their own in-house capacity, The JBL Group can quarterback a winning Reimbursement Submission targeted at multiple levels, including: 

 

• National / Federal level (e.g. ,Common Drug Review (CDR), pCODR, NIHB);
• Provincial Formularies (e.g. individual provincial drug plans, including INESSS in Quebec and the new Pan-Canadian Pricing Alliance – PCPA);
• Private Payers; and
• Hospitals.

CDR Submissions



The largest and most complex reimbursement submission is to the CDR. Submissions are required for Public Payer reimbursement in Canada of any New Chemical Entity (NCE), as well as any new indications for existing drugs. CDR submissions encompass all Provincial Formularies (except Quebec), as well as federal Payer programs. 



Provincial Formulary Submissions



Consultants at The JBL Group have led more than 200 individual Submissions to provincial formularies. Although the components of these submissions are similar to CDR Submissions, the strategy and tactics that lead to successful reimbursement vary greatly, depending on the drug and the policy environment in each specific province. In addition, The JBL Group has expertise in preparing successful Provincial Submissions for pharmaceutical products that are not considered a New Chemical Entity (e.g. line extensions, old chemical entities and formulation changes). 
 
Pan Canadian Pricing Alliance (PCPA)
 
The JBL Group is also on the leading-edge, handling a number of cases under the new, evolving PCPA process and has negotiated numerous Provincial Listing Agreements (PLAs).

 Quebec



Submissions to the Quebec Liste de medicament, in, present their own unique challenges. As well, Submission requirements have been recently updated. Our Consultants are very familiar with these new requirements and The JBL Group is uniquely positioned to liaise with the Institut national d’excellence en santé et services sociaux (INESSS) on behalf of our clients. 



Private Payer Submissions



Private Payer insurance pays for approximately 45% of all drug purchases in Canada. Any new pharmaceutical product in Canada, whether a NCE or not, must file Submissions to Private Payers in order to be considered for reimbursement. The Private Payer community is diverse and includes Insurance Companies, Pharmacy Benefit Managers and Health Benefit Consultants. The JBL Group is familiar with these companies and has experience crafting successful Reimbursement Submissions for each of these unique stakeholders. 



Hospital Submissions



Often overlooked by many companies, Hospital Submissions are another important element to a successful Reimbursement strategy. Each hospital in Canada has a Therapeutics Committee (P&T) that evaluates information on new products intended for use in a hospital setting. The JBL Group can provide all the components necessary to support the creation of winning Hospital Submissions.

The Canadian pharmaceutical market has a multitude of pricing regulations at both the Federal and Provincial levels. It is more critical than ever to our clients that they are armed with the strategic insight necessary to navigate the complex pricing environment in Canada, so that their products can be successfully commercialized here. 
 
The JBL Group offers a broad range of services related to pricing, including:
 

• Strategic Pricing Reviews;
• Pricing Research and Benchmarking;
• Price Setting for new product launches; and,
• Submissions to PMPRB.

 
Consultants at The JBL Group are experts in crafting Regulatory Submissions to both the Patented Medicine Prices Review Board (PMPRB) and Pan-Canadian Pricing Alliance (PCPA).  The JBL Group is on the leading-edge, handling a number of cases under the new and evolving PCPA process and has negotiated numerous Product Listing Agreements (PLAs) on behalf of our clients.
 
The JBL Group also offers:
 

• PCPA Pricing Negotiations; and,
• PLA Strategic Negotiation Support.

Government decisions affecting health care and access to medications can have a profound impact on patients and the health professionals who care for them.  The JBL Group understands that the external stakeholders in the health care sector can play a critical role in determining our clients’ success in terms of Market Access and Reimbursement. 



The professionals at The JBL Group have the experience and specific expertise necessary to assist patients, health care professionals and the groups and associations that represent them to create winning advocacy strategies designed to positively influence policy. We help harness the credibility and influence of our stakeholders.  We help align respected experts and concerned patient organizations around a clear, convincing message and assist them in delivering it to the appropriate decision-makers in a powerful, effective way that gets results.