Question Period Note: COVID-19 CRITICAL DRUG RESERVE

• COVID-19 created an increased demand for drugs used in supporting patients with the disease, against the backdrop of multiple global supply chain challenges. Drug shortages, particularly in the context of COVID-19 critical drugs, could put the health of Canadians at risk.
• Working with provinces, territories and other partners, Health Canada established a COVID-19 Critical Drug Reserve to support patients with COVID-19.

• Ensuring Canadians have access to the drugs they need is a top priority. The Government of Canada has taken proactive measures to help mitigate the risk of drug shortages, a global issue, throughout the pandemic.
• Working with provinces and territories and other partners, Health Canada established the COVID-19 Critical Drug Reserve in 2020.
• This Reserve complements other federal, provincial and territorial drug shortage management efforts, and functions as a safety net by augmenting the supply of key drugs used in treating patients with COVID-19 in Canada.

IF PRESSED ON WHAT DRUGS HEALTH CANADA PURCHASED FOR THE CRITICAL DRUG RESERVE …
• The Critical Drug Reserve holds twelve drugs used in hospitals to support patients with COVID-19, including sedatives, pain relievers, antibiotics, and neuromuscular blockers. These drugs have been included in the Reserve based on Canada’s experience in managing drug supply, consultation with provinces and territories, and advice provided by health care experts.

IF PRESSED ON PARTICIPATION …
• The Critical Drug Reserve functions as an additional safety net in the event of shortages of key drugs used in the treatment of COVID-19 symptoms, and complements Canada’s current drug shortage mitigation measures.
• Participation in the Critical Drug Reserve is voluntary, with most provinces and territories participating. Both Quebec and New Brunswick have opted out, but the Government of Canada will continue to provide support when requested.

IF PRESSED ON COST …
• To date, the Government of Canada has awarded close to $30 million in contracts for drugs in the Critical Drug Reserve through competitive processes that are cost-shared with participating provinces and territories.
• Drug pricing is influenced by a number of factors, including availability, supply chain constraints, global import/export restrictions, and competition in the global marketplace.
• As with all purchasing, value for money was a key consideration.

Health Canada’s role

Health Canada works with provinces and territories and stakeholders across the drug supply chain to identify mitigation strategies, which include regulatory measures and exploring access to alternative products available in other jurisdictions. Creating a reserve for drugs critical to the treatment of COVID-19 symptoms is one such strategy.

During the first wave of the pandemic, shortages were identified for key drugs used in treating patients with COVID-19. The Critical Drug Reserve serves as a backstop for Canada’s existing supply, complements the current drug shortage management systems, and has helped to prevent critical drug shortages, which has in turn, relieved pressures on provincial and territorial health care systems.

Factors that were considered in the pursuit of a critical drug reserve included whether the drug is important for the treatment of COVID-19 symptoms, whether the drug is in shortage or is likely to be in shortage, and whether alternative or substitute drugs are available. The following drugs are in the Critical Drug Reserve:

• Cisatracurium (Neuromuscular blocker);
• Epinephrine (Adrenergic agonists);
• Fentanyl (Opioid analgesic);
• Norepinephrine (Adrenergic agonists);
• Propofol (Sedative);
• Rocuronium (Neuromuscular blocker);
• Salbutamol (Bronchodilator);
• Ceftriaxone (antibiotic);
• Dexamethasone (corticosteroid);
• Hydromorphone (analgesic);
• Midazolam (sedative); and
• Vasopressin (vasopressor).

Engagement with Provinces and Territories

To address drug supply issues, Health Canada has strengthened existing mechanisms for managing drug shortages, and has leveraged existing FPT infrastructure and increased cooperation with multiple partners to identify shortage signals earlier, particularly for critical drugs required for COVID-19.

Given the need for close cooperation on the shortage of critical drugs, a Framework for the Effective Management of Drug supply in the Context of the COVID-19 Pandemic was developed and agreed to by provinces, territories and the federal government. This Framework sets out the common principles for managing drug shortages and guiding decisions in the context of the COVID-19 pandemic. Principles include solidarity, fairness, openness and transparency, and FPT collaboration. These principles have been implemented through the federal government facilitating access to alternative drug supplies to prevent shortages, and building the Critical Drug Reserve to support patients with COVID-19.

The CDR was established as a backstop for a limited period of time and was set to end March 31, 2022. However, due to the prolonged pandemic the reserve has been extended by an additional three months and will now be in place until June 30, 2022.

KEY FACTS
• The Critical Drug Reserve was established with a three month supply of 12 key drugs used in the treatment of COVID-19 symptoms.
• Canada assumed the upfront costs to build and manage the Reserve. The costs are shared 70% / 30% between provinces / territories and the Federal Government.
• Participation in the Critical Drug Reserve is voluntary. All jurisdictions except for Quebec and New Brunswick have opted in, and have accessed drugs from the Critical Drug Reserve.