Why Canada brand drugs are cheaper
It’s cheaper because Canada sets one price for the drug. Every hospital and pharmacy pays that (or a cap under it). In the US, each insurer and PBM bargains a rebate off a high list, and the sticker stays high.
PMPRB ceiling + provincial bulk buys
How it works
PMPRB sets a ceiling on patented drugs. Provinces then bulk-buy (pCPA). Hospitals are global-budgeted, so they cannot turn the vial into a 340B-to-commercial spread. Outpatient drugs are often a separate plan — the gap in Canadian coverage — and still cheaper than US list.
Why it holds
A ceiling plus a bulk buyer. RAND: US brands 3.24× Canada — Canada is about 31¢, the closest peer on brands, and still a third of US. Highest 5% concentration in Wammes (60%) and still cheaper: more of the pile on the sick, at Canadian prices.
The invoices
See RAND drugs. 30-day list prices: CMS 2023, Inflation Reduction Act round 1.
Twenty brands — US sticker vs Canada
Ranked by the US number. 30-day list is CMS 2023 (Inflation Reduction Act round 1). Infusion doses are our hospital commercial bill. Canada column is that US sticker × this country’s RAND brand index. Gross list, not rebates. Even after a US rebate haircut, RAND says brands stay more than 3×.