TABLE 2.

PLAs in other province

Province	PLA Policies	Mechanism	Types of Agreements
Ontario	PLAs are negotiated and concluded since the adoption, in 2006, of An Act to Amend the Drug Interchangeability and Dispensing Fee Act and the Ontario Drug Benefit Act (Bill 102) (Government of Ontario 2006).	No official mechanism.	•Mostly confidential agreements on prices (98%).
	In 2011, the government of Ontario introduced a policy specifically for cancer drugs, allowing the conclusion of CED agreements, called the Evidence Building Program, that aims to “develop and collect real-world data on cancer drugs where evolving evidence demonstrates clinical benefit beyond the current reimbursement criteria” (Cancer Care Ontario 2011).	Listing recommendations may be conditional based on different commitments from pharmaceutical manufacturers (e.g., commitment to the advertisement of the appropriate use of the medication if concerns exist about “off-label” use or specific evidence to identify clinical or economic uncertainties).
Alberta	Policy that stipulates comprehensive parameters for establishing and executing PLAs through a clear, collaborative, predictable and sustainable process.	The Ministry invites manufacturers, via a request for PLA (RFPLA), to submit a PLA proposal. In the RFPLA, the Minister indicates the type of drugs targeted for PLAs and the preferred type of PLA for these drugs. On the basis of the RFPLA response, a pharmaceutical manufacturer can submit a PLA proposal to be evaluated by the Alberta authorities. In their decision on whether or not to recommend the proposed agreement, the authorities take into account the priority status of the pathology, the therapeutic benefits of the medication compared to the comparator, the existence of equivalent drugs, the difficulty of the proposed agreement and the societal benefits that may result from the drug coverage.	PLAs that: •Facilitate improved access to innovative drugs in a timely manner. •Ensure the financial sustainability of the drug plan.
	Four different types of PLAs: (1) price/volume agreements, (2) health research capacity agreements, (3) utilization management agreements and (4) coverage with evidence development agreements (Alberta Health and Wellness 2011).
Other provinces	No formal PLA policies.	Willingness of some provinces to implement clear guidelines in order to regulate this process.
	Pan-Canadian agreements (in which Quebec has not participated) have been concluded for bulk purchasing, e.g., Soliris (IMS Brogan 2011).
	Canadian provinces, except Quebec, concluded an agreement on bulk purchasing for six generic drugs after April 1, 2013: Atorvavastatin, Ramipril, Venlafaxine, Amlodipine, Omeprazole and Rabeprazole (Lunn 2013).	Atlantic provinces are currently working on a common PLA policy draft that should be similar to the Alberta PLA policy, except that no “health research capacity agreement” will be included in the guidelines. This is due to the fact that the biopharmaceutical industry is not developed in these provinces and thus, is not a priority.