The paper covers the entire life cycle of the drug market in Canada starting from how drugs are approved for sale and priced, through to the purchase and reimbursement of drug costs. [...] The loss of patent protection for a number of blockbuster brand drugs, coupled with aggressive generic pricing reform by the provinces for the benefit of all payers, has resulted in a moderation in the growth of drug cost in the last couple of years. [...] In this regard, until the mandate and operations of the PMPRB have been amended, we believe that the PMPRB should expand the list of comparator countries that are used to calculate the Median International Price Comparison with an eye to ensuring that the comparator countries are more representative of the OECD as a whole. [...] Provincial Listing Process Once a drug is approved for sale in Canada by Health Canada and its reference price has been established by the PMPRB, the provinces, collectively, conduct a "value for money" assessment of new drugs as a key step in the decision on whether or not to list the new drug on the provincial formulary. [...] At the moment, the respective mandates of the CDR/pCODR/INESSS address only drugs and not the tests and this represents a gap in the regulatory environment in Canada.