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• Access to Medications
• Cost Containment
  • Bulk Purchasing
  • Reference Based Pricing
  • Therapeutic Substitution
  • Tendering
• Pharmaceutical Task Force
• Pharmacy Agreement in BC

What is Tendering?

In an effort to contain costs, governments have begun to implement tendering processes for acquiring medications to be listed on public drug plans.

Tendering is a process in which government, as payer, negotiates the lowest price for a pharmaceutical drug¹. In exchange for this low price, the supplier of the drug gets their product listed on the public drug plan. Often, the lowest bidder becomes the sole tender meaning their drug is the only one available in an entire class of drugs (such as statins) to patients on the public drug plan².

Sole product tendering is particularly problematic for patients when it is done across a class of drugs as it results in a form of therapeutic substitution. In these cases, patients are forced to switch from the drug prescribed by their doctor to another drug that is chemically different from the one they were prescribed. In some cases, patients have been forced to switch numerous times as governments re-negotiate their contracts and award different companies sole tender³.

Here are some of the Better Pharmacare Coalition's serious concerns about the impact of tendering on the health of BC patients and the health system:

• Severely limits patient and physician choice to the single cheapest drug in an entire class.
  
  
• Results in a form of therapeutic substitution forcing patients to switch medications as tenders expire and are renewed.
  
  
• Focuses all attention on 'the bottom line', which clearly displaces patients' needs.
  
  
• Discourages research, investment and economic growth as it promotes a 'winner takes all' environment and creates stagnation in scientific discovery, advancement and intellectual property rights.
  
  

Better Pharmacare Coalition position:

• We feel that the health of BC patients come first. Patient care is enhanced by increasing choice; limiting choice to innovative medications flies in the face of patient individuality.
  
  
• The Better Pharmacare Coalition does not support horizontal tendering across a class of medications, which forces patients to switch medications that are chemically different.
  
  
• The Better Pharmacare Coalition does support tendering processes for drugs that have been shown to be chemically identical (such as generics).
  
  
• The Better Pharmacare Coalition recommends that BC PharmaCare should work closely with the Purchasing Commission, a BC health economist expert in the area of unintended consequences of tendering, and other experienced procurement bodies to examine the ramifications of tendering and consider the examples in other countries such as New Zealand before making decisions on procurement and tendering.
  
  
• All tenders should be evaluated across the board by the various stakeholders affected, focusing on the impact on patients and the ability for physicians to provide quality care.
  
  

1. LeLorier, J. (2007). "Lessons for a national pharmaceuticals strategy in Canada from Australia and New Zealand" in Health Outcomes and Public Policy, Vol 23(9): 711-718.
2. Ibid
3. Begg et al. (2003) "Sorry saga of statins in New Zealand" in NZMA, Vol. 116(1170)

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