Provincial drug benefit programs
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* Manfred Harth

I hope that Andreas Laupacis' essay on provincial drug benefit programs will start an overdue debate on the decision-making processes involved in these programs.1 As a rheumatologist practising in Ontario, I have often been frustrated by the inadequacy of limited use criteria for drugs that I wish to prescribe, for example, certain bisphosphonates. Even more frustrating is the slowness with which the program deals with new and important agents such as etanercept, for which, at the time of writing, special requests still have to be made under Section 8. For drugs in this category, physicians must submit a written request to the Drug Programs Branch of the Ministry of Health and Long-Term Care indicating the reason why the drug is required for a particular patient.

If the Therapeutics Committee of the Ministry of Health and Long-Term Care makes its decisions from a societal perspective, then it should welcome transparency and conduct open meetings. It must, at least, request the views of interested parties other than of just the pharmaceutical companies when considering submissions. We would all like to see better evidence that the committee usually makes reasonable decisions.

**Manfred Harth** Division of Rheumatology Department of Medicine University of Western Ontario London, Ont.

## Reference

1.  1. Laupacis A. Inclusion of drugs in provincial drug benefit programs: who is making these decisions, and are they the right ones? CMAJ 2002;166(1): 44-7.
    
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