Lessons from Canada’s notice of compliance with conditions policy for the life-cycle regulation of drugs

Melanie McPhail, Howard Zhang, Zohra Bhimani, Tania Bubela

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Innovative health technologies are not well regulated under current pathways, leading regulators to adopt contextual, life-cycle regulatory models, which authorize drugs based on earlier clinical evidence subject to the conduct of post-market trials that confirm clinical benefit and safety. In this paper, we evaluate all drugs authorized in Canada under the Notice of Compliance with conditions (NOC/c) policy from 1998 to 2021 to analyze its function, identify challenges and areas for improvement, and make recommendations to inform Health Canada’s regulatory reforms. We analyzed a sample of 148 drugs authorized between 1998 and 2021, including characteristics about the pre- and post-market clinical trials, finding that most NOC/c authorizations are based on one, single-arm clinical trial using a surrogate endpoint. Post-market trials are more likely to be randomized, Phase III trials but mostly use surrogate endpoints. Based on our findings, we recommend increasing decision-making transparency throughout the regulatory process, developing comprehensive eligibility criteria for selecting appropriate health technologies, modernizing pre-market evidence requirements, adopting a more active role in designing post-market trials, and utilizing automatic expiry, stronger penalties, and ongoing disclosure of the status of post-market trials to promote compliance.

Original languageEnglish
Article numberlsad008
JournalJournal of Law and the Biosciences
Issue number1
Publication statusPublished - 1 Jan 2023
Externally publishedYes


  • conditional regulation
  • drug regulation
  • health law
  • health technologies
  • life-cycle regulation
  • regulatory science


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