Sanofi has signed a letter of intent with the pan-Canadian Pharmaceutical Alliance (pCPA) for Dupixent (dupilumab), covering four indications that span dermatology and respiratory care. The agreement, reported by the Financial Times, signals that negotiated pricing terms for the biologic are now in place at the national level, clearing a key administrative hurdle before provincial drug plans formalize coverage.

For dermatology clinics, the practical stakes are straightforward. LOIs with the pCPA are the mechanism by which Canada's provinces collectively negotiate prices for new drugs and new indications. When one is signed, public plan listings usually follow. Patients who today pay out of pocket, or rely on private insurers with restrictive criteria, move a step closer to first-dollar coverage.

What does a pCPA letter of intent actually change?

An LOI is not a reimbursement decision. It's the pricing agreement that makes one possible. The pCPA negotiates on behalf of all provincial, territorial and federal public drug plans, so a single letter sets terms nationally rather than province by province. Each plan then decides independently when and how to list the drug.

That means Canadian dermatologists prescribing Dupixent should watch two things in the coming months: the timing of individual provincial listings, and the eligibility criteria each plan attaches to them. Formulary criteria often lag behind the full approved label, and prior-authorization requirements can shape real-world prescribing more than the clinical trial data does.

Dupixent's dual footprint matters here. A single agent with indications across dermatology and respiratory care gives prescribing physicians one negotiated price and one reimbursement pathway spanning specialties. For practices managing patients who move between dermatology and respiratory clinics, aligned coverage terms reduce fragmentation.

Why this matters for access

The letter of intent covers four indications in total. For a biologic already established as a category leader in type 2 inflammatory disease, broadening public reimbursement across multiple indications is the difference between a drug for well-insured patients and a drug for the general clinic population.

In plain words: the price is agreed, and now the provinces decide who actually gets it.