Through the CADTH Common Drug Review (CDR) process, CADTH undertakes the review of drugs, and issues formulary listing recommendations to all federal, provincial, and territorial drug plans that participate in the CDR process (hereafter referred to as the "drug plans"). The review process has a targeted performance metric of 180 calendar days from the time that an application is accepted for review to the date of issuing the embargoed Canadian Drug Expert Committee (CDEC) recommendation. Simplified descriptions of the main phases of the CDR process are subsequently provided. Please refer to the Procedures for the CADTH Common Drug Review and Interim Plasma Protein Product Review for complete details.
1. Pre-submission Phase
1.1 Pre-submission Meetings
To facilitate the efficient preparation and filing of submissions for review under the CDR process, sponsors may request a pre-submission meeting with CADTH to introduce the drug and discuss submission requirements. Sponsors are limited to one pre-submission meeting per eligible drug submission, and the meeting must occur prior to the submission being received at CADTH.
1.2 Advance Notification Procedure
Sponsors are required to provide CADTH with a minimum of 30 business days of advance notice for anticipated submissions and resubmissions. To fulfill the advance notification requirement, sponsors must complete the CADTH Common Drug Review Advance Notification Form in its entirety and submit it to CADTH (firstname.lastname@example.org). The 30 business day notification period will be counted from the date of receipt of the advance notification form to the targeted filing date for all anticipated submissions.
2. Application Phase
2.1 Filing an Application
Sponsors must file the application in accordance with the content, format, and organization stipulated in the Procedures for the CADTH Common Drug Review and Interim Plasma Protein Product Review. All applications filed by sponsors for drugs are subject to an application fee.
2.2 Application Screening
CADTH screens applications in the order they are received and in accordance with the requirements and checklists described in the Procedures for the CADTH Common Drug Review and Interim Plasma Protein Product Review. The screening period for a submission or resubmission is 10 business days. Note: The date the submission is received at CADTH is considered day zero for the purposes of calculating timelines. Once the submission has been accepted, the key milestones for the review are posted on the CADTH website.
3. Patient Input
Patient input provides patients' experiences and perspectives of living with a medical condition for which a drug under review is indicated, their experiences with currently available treatments, and their expectations for the drug under review. The call for patient input is posted 20 business days in advance of the sponsors's anticipated date of application filing, as provided in the mandatory notification. A total of 35 business days is provided for preparing and submitting patient input. All patient input received by CADTH for the drug under review is collated and summarized by CADTH staff. This summary, as well as the patient input received, are used by CADTH in the development of the review protocol and to assist CDEC in their deliberations.
4. Review Phase
4.1 Initiation of a CDR Review
All applications are assigned to the work schedule on a first-come, first-served basis, as determined by the date they are accepted for review — with the exception of requests for advice and drug plan-initiated reviews. All drugs are initiated within 1 to 10 business days of acceptance for review. The initiation dates as well as other key milestones are confirmed only once the submission has been accepted for review.
4.2 Type of CDR Review Conducted
CADTH conducts one of the following types of review:
- A standard review consists of CADTH conducting a systematic review of clinical evidence provided by the sponsor along with studies identified through its independent, systematic literature search, and an appraisal of the sponsor-provided pharmacoeconomic evaluation.
- A tailored review consists of the CADTH conducting an appraisal of the clinical evidence and pharmacoeconomic evaluation filed by the sponsor using a CADTH-provided review template that is specific to the type of drug product to be reviewed.
For new combination products and new formulations of existing drugs, sponsors must submit a completed tailored review application form to CADTH before filing the submission. CADTH will assess the information and confirm the type of submission (standard or tailored) to be filed by the sponsor.
4.3 CADTH Clinical and Pharmacoeconomic Review Reports
CADTH prepares Clinical and Pharmacoeconomic Review Report(s) in accordance with the appropriate review template (e.g., standard review or tailored review). Sponsor are given the opportunity to review and provide comments on the draft CADTH review report(s) before they are finalized and distributed to CDEC. For transparency, CADTH posts all CADTH review report(s) on the CADTH website. Sponsors are responsible for the identification of confidential information in the CADTH review report(s) prior to the reports being posted.
5. Recommendation Phase
CDEC is an advisory body to CADTH that makes drug-related recommendations and provides drug-related advice through the CADTH CDR and therapeutic review processes. CDEC's recommendations and advice are provided to CADTH to inform the drug plans and a range of stakeholders. CDEC members' deliberations take into account patient group input, clinical studies demonstrating the safety, efficacy, and effectiveness of the drug, therapeutic advantages and disadvantages and cost and cost-effectiveness relative to current accepted therapy. Following deliberation of the available evidence, CDEC may recommend one of these options for a drug under review: that a drug be reimbursed; that a drug be reimbursed with conditions; or that a drug not be reimbursed.
The CDEC meeting schedule is available on the CADTH website.
5.2 Embargoed Recommendation
Confidential embargoed CDEC recommendations are distributed to the sponsor and drug plans 8-10 business days following the CDEC meeting. For the 10 business day embargo period following distribution, the CDEC recommendation is limited to the sponsor and the drug plans. The intent of the embargo period is to allow time for the sponsor and CDR-participating jurisdictions to consider the embargoed CDEC recommendation before it is made public. During the embargo period, the following may occur with respect to the embargoed CDEC recommendation: the drug plans may submit a request for clarification, and/or the sponsor may make a request for reconsideration or file a resubmission based on a reduced price.
5.3 CDEC Final Recommendation
When a CDEC final recommendation is issued, CADTH sends the recommendation to the drug plans and the sponsor, and posts a copy on cadth.ca. CDEC recommendations are non-binding to the drug plans. Each drug plan makes its own drug-listing decisions based on the CDEC final recommendation in addition to other factors, including the plan's mandate, priorities, and resources.
6. Transparency of the CADTH Common Drug Review Process
For transparency, the following documents are posted on cadth.ca:
- Key milestones for reviews
- CDEC Final Recommendations
- CADTH Clinical and Pharmacoeconomic Review Report(s), as applicable to the type of review conducted
- Patient Group Input Submissions
Additional brief information videos regarding CDR are available, as follows:
Overview of CDR
CDR Patient Input Process