The time has come for universal pharmacare

Posted on October 29, 2015 in Health Debates

TheStar.com – Opinion/Commentary – One in five Canadian households cannot afford the prescription medicines they need. It’s a crisis with only one solution.
Oct 29 2015.   By: Roy Romanow, Greg Marchildon

Momentum has been building for national pharmacare for the past year. The time has come — in fact it is long overdue — for federal, provincial and territorial leaders to sit down and work out a plan.

The need is great. Private coverage through employment plans do not include those who have minimum wage, temporary or seasonal jobs. Provincial safety net plans vary considerably in breadth and depth of coverage such that it makes a big difference whether you live in Atlantic Canada or the rest of Canada. And even with private or public coverage, many Canadians cannot afford the copayments and deductibles associated with their prescription medication costs. As a consequence, one in five Canadian households cannot afford the prescription medicines they need.

At the same time, we are paying far too much for drugs in Canada. Fragmented plans and the lack of a national formulary have led us to have the second highest prescription drug costs of all countries in the OECD.

Our new prime minister has said we should always strive to do better in Canada. As one of the only OECD nations with a universal health plan that does not include prescription drugs, the time has come for us to do better.

As we look with optimism to a new government in Ottawa, it is time to push hard for a version of pharmacare that will truly address our challenges. The incoming prime minister has said that he wants to sit down with the premiers very soon. However, it will be tempting for all governments to take the easy way out and do something that falls far short of universal pharmacare. For example, the C.D. Howe Institute recently recommended catastrophic coverage as a more feasible option.

In the Romanow Royal Commission report of 2002, we saw catastrophic coverage as a minimum, short-term step on the road to universal pharmacare for carefully selected medicines. Since then, almost all provinces have put catastrophic coverage in place. But the way in which catastrophic coverage has been implemented means that it only kicks in when costs exceed very significant levels. These plans do not help Canadians with many of the day-to-day drugs that manage chronic disease. While spending in many families will never clear the catastrophic bar, the health consequences for not taking the medicines are catastrophic — and the reality is that they are unaffordable for many.

Furthermore, in spite of our hopes that it could be a first step to real pharmacare, catastrophic coverage appears to be giving some governments the excuse not to do the hard work to make coverage truly universal for Canadians and affordable to taxpayers.

Some will argue in favour of the Quebec model of layering public coverage on private insurance plans. While this can achieve universal coverage it can never bring prices down in a way that is affordable to taxpayers. We would be stuck, almost indefinitely, with the highest prescription drug costs in the OECD.

Neither catastrophic drugs nor the Quebec model can deliver all four critical elements of a universal pharmacare program:

– Universal access on the same terms and conditions to a core list of prescription medicines;

– A single, national formulary based on clinical and cost effectiveness;

– Price negotiations and bulk purchasing by a single payer from the pharmaceutical companies in order to reduce prices;

– A quality agenda at the clinician-patient level to reduce over-prescribing and inappropriate prescribing of drugs.

In fact, some version of all these elements was included in the National Pharmaceuticals Strategy negotiated in the 2004 Health Accord, which was killed by the Harper Conservatives. It would be hard to imagine the Trudeau government would want to aim lower, particularly when some premiers and provincial health ministers have made it clear they want a truly national approach now.

If better is always possible, the time to do better is now. Nothing less than the health of Canadians and the sustainability of our systems is at stake.

Roy Romanow was premier of Saskatchewan from 1991 until 2001 and sole chair of the Royal Commission on the Future of Health Care in Canada.

Greg Marchildon was executive director of the Royal Commission and is Ontario Research Chair in Health Policy and System Design at the University of Toronto.

< http://www.thestar.com/opinion/commentary/2015/10/29/the-time-has-come-for-universal-pharmacare.html >

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2 Responses to “The time has come for universal pharmacare”

  1. I am in complete agreement with this article.

    Canadians would benefit a great deal from a national pharmacare program. The reason I say this is because even though our country does have universal health coverage, many people cannot afford to pay for their prescription. When an individual goes to the hospital, the medication given at the hospital to treat the patient is in fact covered by our universal health plan. The problem is, as soon as the patient leaves the hospital with a prescription written by a doctor (antibiotics to treat infection, anti-arrhythmic medicines for heart conditions…etc), the individual must pay for the medication unless covered by health insurance/benefits. The fact that many employment opportunities are now part-time jobs does not help the situation. Part-time employment does not usually offer benefits for their workers which leads to not having pharmaceuticals covered for the employee as well as their family. Unfortunately, because of this issue, people tend to wait in emergency rooms so that they can be treated with the proper pharmaceuticals for free. This tends to create problems with longer wait times and poor bed availability for patients with serious illnesses or injuries.

    The health of Canadians should be the number one priority for our federal government. Having said that, the federal government should join the territories and provinces in order to make national pharmacare a reality. Pharmacare would be able to protect our citizens, especially those who are in definite need, from having to pay for the essential prescribed medications.

    I believe that our Prime Minister Trudeau can make pharmacare happen. As shown in the article, there are many other beneficial aspects that can change our health care for the better. I am hoping that Canada’s 150th anniversary (2017) brings something for it’s citizens to celebrate. The celebration of pharmacare!

  2. The title of this article could not be more accurate. While Canadians are proud of our universal health care, it is lacking in some areas including pharma care. While some have pharma care through their employer’s benefits and others are covered through social security programs like Ontario Works, pharma care coverage is weak and inconsistent overall.

    In my volunteer and social work placements I have encountered many clients who have had to make a choice between doing without their medications or other necessities to pay for those medications. Today’s labor market is increasingly one with part time, temporary and contract jobs that do not offer benefits of any kind. This puts a severe financial strain on many working Canadians to pay for medications they need not just to function but often to be able to continue to live.

    Undoubtedly it will require a great deal of money initially which will may make it a hard sell to cash strapped governments trying to reduce deficits. However in the long term this program can save the health care system money as a preventive measure similar to the flu shot. If everyone is able to afford their medications, this will help them have better health and reduce costs to the system of increased doctor visits or having to go to the hospital. I hope the new government will take advantage of the good will it currently has to take a serious look at a universal pharma care program.

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