Social Policy in Ontario

Every year millions of Canadians split pills, don’t fill prescriptions and are late in paying their rent. Some even skimp on food in order to afford prescriptions vital to their health.

This happens in part because Canada lacks a national pharmacare program. Unlike other developed countries, we continue to purchase drugs with a large army of drug payors, each lacking the clout of what a single national purchaser would wield when at the bargaining table for prescription drug purchasing.

To worsen matters, doctors and nurse practitioners have little knowledge of how much drugs actually cost. They currently have no simple and reliable way to know and communicate drug prices to patients.

As a result, already time-strapped prescribers consciously choose to ignore the subject of drug cost. This causes direct harm to patients and their families, worsens cost efficiency and erodes the very sustainability of universal health care.

The combination of not having national pharmacare taken with prescriber ignorance of drug costs is doubly disastrous. The dismal fact is that Canada continues to spend more money per person per year on prescription drugs than almost any other developed country in the world.

Patients attend clinics with the mistaken notion that physicians and nurse practitioners are acutely aware of the prices of their drugs. The common belief is that drug price and affordability is carefully weighed; however, this presumption is mostly false.

Few patients are aware that doctors do not know drug costs. They even fear that doctors knowing drug prices potentially conflict with getting the best care. They may worry that the quality of care may be degraded just so a less expensive drug is prescribed.

What they fail to realize is that, however cost-savvy, physicians remain morally and legally obligated to offer the best evidence-based choice, price notwithstanding.

Knowing drug costs can have a huge impact in allowing physicians to choose drugs more cost effectively between drugs that have the same effect and are equally safe.

This is not simply a matter of trade vs. generic drug prescribing. It extends to drugs prescribed within categories. For example, perindopril and ramipril are drugs within the same category that both treat high blood pressure. If doctors knew that perindopril costs $130 and ramipril only costs $30 they would more likely prescribe the latter since both have equivalent effects.

It may come as a surprise, but the less expensive drug is often the superior therapeutic choice. Paying more for a medication may be less likely to result in improved outcomes.

Newer drugs, because they are newer, have been subjected to fewer clinical trials and have been studied less. The body of research proving a newer drug’s safety and efficacy may be dwarfed by that of its older equivalent drug. And it is often that same older drug that winds up costing less — sometimes much less — than its newer equivalent.

Ongoing prescriber ignorance of drug prices is a serious problem. But so is not having a national pharmacare plan. Taken together, these gaping holes are very costly to the individual, to the insurance provider, to our ministries of health and to the future of drug pricing.

Starting and instituting a national pharmacare program is difficult and will take strength and determination.

Informing doctors and nurse practitioners about drug costs is easy. The provincial formulary drug prices can pop up automatically when prescribing. Mandating drug cost transparency on the electronic medical record educates physicians and patients about drug costs. It helps to ensure that patients will be able to afford their prescriptions when they go to the pharmacy. This improves their health and lessens clinic and hospital visits.

If and when national pharmacare should become a reality, drug cost transparency will allow physicians and nurse practitioners to be better stewards of the public purse.

It is only at this point that we can we assert any authentic claim to providing truly cost-effective care.

Iris Gorfinkel, M.D., is a general practitioner and founder and principal investigator of PrimeHealth Clinical Research in Toronto.Joel Lexchin, M.D. is an emergency room physician and professor emeritus at the School of Health Policy and Management at York University in Toronto.

https://www.thestar.com/opinion/contributors/2018/04/02/knowing-drug-prices-enhances-quality-of-care.html