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Unlike other high-income countries, Canada has no national policy for drugs treating rare diseases (orphan drugs). Nevertheless, in 2022, the Canadian government committed to creating a national strategy to make access to these drugs more consistent. Our aim was to study whether recommendations made by the Canadian Agency for Drugs and Technology in Health (CADTH) translated into coverage decisions for orphan drugs in Ontario, the largest Canadian province. This study is the first to look at this question for orphan drugs, which are at the center of policy attention. We included 155 orphan drug-indication pairs approved and marketed in Canada between October 2002 and April 2022. Cohen's kappa was used to test the agreement across health technology assessment (HTA) recommendations and coverage decisions in Ontario. Logistic regression was used to test which factors, relevant to decision-makers, might be associated with funding in Ontario. We found only fair agreement between CADTH's recommendations and coverage decisions in Ontario. Although a positive and statistically significant association between favorable HTA recommendations and coverage was found, more than half of the drugs with a negative HTA recommendation were available in Ontario, predominately through specialized funds. Successful pan-Canadian pricing negotiations were a strong predictor of coverage in Ontario. Despite efforts to harmonize access to drugs across Canada, considerable room for improvement remains. Introducing a national strategy for orphan drugs could help increase transparency, consistency, promote collaborations, and make access to orphan drugs a national priority. • Recommendations by the Canadian Agency for Drugs and Technology in Health do not always translate to provincial coverage decisions for new drugs. • We explored whether Canadian Agency for Drugs and Technology in Health's recommendations are aligned with coverage decisions for orphan drugs in Ontario. • Negative health technology assessment recommendations did not necessarily translate to no pan-Canadian pricing negotiations. • More than half the drugs with negative health technology assessment recommendations were available in Ontario through specialized funds. • A national strategy for orphan drugs could prioritize access to these treatments at a national level and harmonize access, at least to some extent, across Canada. [ABSTRACT FROM AUTHOR]

The present study empirically investigates whether targeted government spending and environmental policies promote green growth, as measured by greenhouse gas productivity. Government spending for pollution abatement (GEPA) represents non-market environmental policies encompassing both enforcement regulations and stakeholder incentives, while policy dummy represents province specific targeted environmental policies. Using panel data from 1995 to 2020 across ten provinces of Canada, an empirical model based on STIRPAT has been developed and estimated, addressing various econometric issues to ensure the robustness and consistency of the results. The findings confirm that both GEPA and targeted environmental policies are crucial determinants in achieving green growth. Additionally, variables such as business sector expenditures for R&D, the share of renewable energy, per capita GDP, and population also contribute to green growth. These results highlight the importance of the stick-and-carrot approach as a key strategy and policy tool for sustainable development. The implications of these findings extend beyond Canada and hold valuable lessons for emerging and developing countries that predominantly rely on command-and-control regulations without adequate support. To effectively address the challenge of achieving green growth, a coordinated approach that combines targeted government spending and environmental policies, supported by innovation and renewable energy exploration, is essential. Overall, this study's findings have significant implications for environmental sustainability on a global scale. [Display omitted] • Examines the effect of targeted government spending and environmental policies on green growth in Canada. • Uses greenhouse gas productivity as an index of green growth. • Estimates the empirical model developed addressing advanced econometric issues related to panel data for 1995–2020. • Controls renewable energy, innovation, per capita income, population. • Have significant implications for environmental sustainability on a global scale. [ABSTRACT FROM AUTHOR]