What’s Next For Pharmaceuticals in Canada? An Engineer’s Vision
January 21, 2026
20Sense’s Arif Mitha tells the story behind the numbers
Over the past 10 years, Arif Mitha has been using facts, figures, and his unique analytic lens to make sense of the Canadian pharmaceutical space for 20Sense. An industrial engineer by training, Arif found his sweet spot as 20Sense’s head of real-world data and evidence research, with a focus on optimizing pathways and processes to support timely and equitable patient access. Here, Arif steps into the foreground to offer his thoughts on the progress and pain points in the Canadian drug ecosystem, and his hopes for the decade ahead.
LOOKING BACK
I would sum up the past 10 years as a “decade of more.” More innovation, more curative treatments, more attention to rare diseases, and overall more options for patients.
As an example, a decade ago, we had no biosimilars, and now we have a sustainable biosimilar market in Canada. These drugs, which typically cost 25% to 50% less than their corresponding reference biologics,1 make it possible for budgets to be invested into the next set of innovative drugs. At the start of 2019, fewer than one in 10 biologic drug claimants received a biosimilar; by the end of 2024, with biosimilar-first coverage policies in effect in public plans across the country, 56.9% of biologic claimants in private plans took a biosimilar.2 I see that as a win for Canadian patients, because it’s freeing up funds for new drugs.
We’re seeing more patient support programs (PSPs), too. A decade ago, we had just a handful of PSPs and just a few vendors. Today, the number of programs tops 400 and PSPs have entrenched themselves into the Canadian drug ecosystem.
Economies of scope
Multipurpose medications – single medications with multiple indications – have a lot going for them: they serve larger numbers of patients and create efficiencies across the healthcare ecosystem. In fact, Canada’s drug pipeline is moving in exactly this direction. “We’re seeing a shift away from the old one-indication model and moving toward a multi-indication model,” says Mark Omoto, General Manager, IQVIA Canada, Thought Leadership & Marketing. Omoto expects such multipurpose products to become the new norm within the pipeline. “Companies will be looking at stacking indications, rather than sequencing them,” he explains. “Novel drugs will be conceived as multipurpose from the get-go, resulting in ‘a pipeline within a product.’ ”
LOOKING AHEAD
Here are two things that I hope improve in the Canadian drug ecosystem over the next decade.
Firstly, access to state-of-the-art medications still takes far too long and remains inconsistent across the country. Not only has the drug approval process remained frustratingly slow, but the time from approval to public reimbursement sits at 598 days,3 putting Canada in 19th place among the top 20 OECD countries.4 The figure sits even less comfortably when you consider that Canada spends 11.2% of GDP on healthcare, significantly more than the OECD average of 9.2%.5 We know that faster access can be achieved – so why can other countries do it and we can’t? I like to think of it in this context: it’s the same drugs, with same clinical trial data, but Canada has longer timelines. Why? Is it a case of (lacking) process optimization?
Secondly, access is not just about drugs, it is also about access to healthcare. An estimated 6.5 million Canadians don’t have a family doctor or nurse practitioner they see regularly, and the problem is reportedly worsening.6 It often falls to family doctors to make or suggest an initial diagnosis. We need to find a way to speed up the diagnostic process so patients can get started on appropriate treatments earlier. In my ideal scenario, the system supports family doctors in making proactive diagnoses and also enables them to focus on preventive health measures, to the benefit of both individual and overall public health.
DATA TO THE RESCUE? SAYS THE ENGINEER…
The potential of real-world data (RWD) applications has me especially excited. Healthcare decision makers have not (yet) fully embraced RWD. However, I think the onus is also on the RWD generators and collectors to ensure it meets rigorous quality standards, which will help to earn the trust of those evaluating the data. Evaluators need to figure this out as well: for better or worse, RWD is different from clinical trial data. As an engineer, we often frame value as cost vs. outcomes, so tracking how therapies actually perform in the real world Canadian population makes perfect sense. Value is the goal and data is the vehicle.
This brings us to Artificial Intelligence (AI). AI needs good data to do its job properly. What opportunities do I see? First up: using AI as a diagnostic tool. I envision AI providing a preliminary diagnosis, which a healthcare provider can then validate. The result? A faster diagnosis and fewer diagnostic errors. Imagine AI running through mountains of data finding patients that match your characteristics, comorbidities, symptoms, family history, and providing a list of possible diagnoses with probabilities, which supplemental tests can rule in or out – rather than the current state of limited physician time, different levels of experience, and possible biases. I’ve seen many of physicians in my life, and I can’t say that any of them have treated or diagnosed me in the same way. I, for one, look forward to my physician using an AI assistant.
On a larger scale, using AI intelligently in doctors’ offices would free up physicians’ time so they can see more patients. By the same token, AI can use data to identify undiagnosed patients. A case in point: Healthcare data company IQVIA has developed an AI algorithm that sifts through medical databases to identify undiagnosed patients.7 This is a fantastic example of how to use AI in the pharmaceutical space: using AI to help physicians diagnose faster and better.
On a more fundamental level, we need to become more comfortable using technology in healthcare. Why, for example, does my doctor not have the notes from my visit to a walk-in clinic? If I need a blood test, why do I have to bring a sheet of paper to the lab? Also, 1960 called and they want their fax machine back.8 I eagerly anticipate a truly integrated system for healthcare services. This has already happened in private healthcare and in other industries. It’s not revolutionary and entirely doable!
Looking good: AI on the horizon
As of October 2025, Canada is driving forward with 170 active AI initiatives, with 13% of them concentrated in specialty clinics.9 “It’s encouraging to see that technology is being strategically leveraged to support patients and healthcare providers navigating the specialty medicine journey,” says Shelley Burnett, President of Auxita Inc. “Communication and coordination is emerging as the second-most common application, underscoring the value of integration.”
THE MOST IMPORTANT QUESTION: ARE CANADIANS GETTING HEALTHIER?
We currently have a system that rewards practitioners on the basis of usage, rather than health outcomes. Should we be changing the model? Perhaps following the lead of England, for example, where the Quality and Outcomes Framework provides bonuses to primary care practices for achieving outcomes such as managing blood pressure and promoting smoking cessation? 10 What gets measured gets done. Today, we are measuring utilization; we can change this.Ultimately, one question matters more than all others: Are Canadians getting healthier? In the current usage-based health system, the question is difficult to answer. Should we be tracking different metrics? Should we find new ways to motivate both doctors and patients to seek better health outcomes? How about a dashboard with all the treatments for a health condition (i.e., cholesterol), number of patients treated with each one, costs of each treatment, and health outcomes achieved? This type of “category management” would help us understand the value achieved from each therapy. Again, it’s all doable, as long as we use the RWD at our disposal and set up good data systems to track outcomes. By the way, these ideas are not new or far-fetched – they are clearly articulated in the principles of value-based healthcare, which we should be striving to implement in Canada as much as possible.11
AN ENGINEER MAKES THREE WISHES
To recap, here are my top-three healthcare wishes:
1. AI assistance for doctors to support diagnosis and treatment selection.
2. Incentives for physicians to achieve health outcomes, instead of payment based on utilization.
3. Treatment ‘category management’ leading to value-based healthcare.
Hopefully I’ve provoked some thoughts and ideas, with the caveat that I come from an analytical perspective and may not have a full view of the healthcare system. I’ve also asked a lot of questions here… will the next 10 years bring us some answers? (I just did it again – sorry.) Whatever comes down the chute, 20Sense will be tracking it, talking about it, and aiming to be part of the change we want to see.
References
1. 2025 drug data trends & national benchmarks. Telus. https://resources.telushealth.com/en-ca/the-2025-drug-data-trends-national-benchmarks-report-is-here
2. Enhance your health benefits without extra spend. Biosimilars Canada. https://biosimilarscanada.ca/save-big-with-biosimilars/
3. IQVIA Market Access Metrics, December 2024.
4. More than just medicines: Canada’s innovative pharmaceutical industry is contributing to the country’s overall health. Innovative Medicines Canada. February 26, 2024. https://tinyurl.com/y9h97m8x
5. How does Canada rank in healthcare? Canadian Medical Association. https://www.cma.ca/healthcare-for-real/how-does-canada-rank-health-care#:~:text=It%20depends%20on%20who%20you,2023%20International%20Health%20Policy%20Survey
6. Why is it so hard to find a family doctor? Canadian Medical Association. https://www.cma.ca/healthcare-for-real/why-it-so-hard-find-family-doctor
7. Recruiting rare disease patients just got easier. IQVIA. November 7, 2022. https://www.iqvia.com/library/white-papers/recruiting-rare-disease-patients-just-got-easier
8. When was the fax machine invented? eFax. Last updated July 7, 2025. https://www.efax.com/blog/brief-history-of-the-fax-machine
9. AI in Action: Transforming Clinical Care Across Canada Working Group. Digital Health Canada. https://digitalhealthcanada.com/membership/chief-executive-forum/inititatives/ai-in-action/
10. Quality and Outcomes Framework: guidance for 2025/26. National Health Service England. https://www.england.nhs.uk/publication/quality-and-outcomes-framework-guidance-for-2025-26/
11. Porter ME. Value-based healthcare delivery. Ann Surg 2008;248:503.