Pharmacare has become a much-debated topic in Canada. In Ontario, the New Democratic Party has promised it as part of their spring election platform, while the Liberals have committed to scrapping the deductible and co-pay for seniors (seniors already receive free medications). All this amid Eric Hoskins leaving as Ontario’s health minister to chair an advisory council on a national pharmacare program – have I lost you yet?
Access to and coverage for prescription drugs is rightly top-of-mind. In some cases, people are kept alive by their medication and in others, their quality of life is greatly improved. In Canada – a country that prides itself on universal health care – 12 per cent of Canadians lack the financial means to pay for their prescriptions. This is not acceptable.
We have a patchwork of drug plans that cover different groups of people depending on where they live, but some people are not covered at all. Ensuring that Canadians have access to prescription drugs should be a top priority. To be perfectly clear, I am in favour of prescription drug coverage for all. However, blowing up the existing system to fill the gap is not the right answer.
I challenge policymakers to explain how we would pay for this, and how they can ensure we won’t end up with a new patchwork of plans. What are we receiving, what are we getting rid of, how much will it cost, and how will it be achieved?
Let me take a step back. More than 85 per cent of Canadians have drug coverage, either through the government, employer, union or individual coverage. There are opportunities to improve efficiencies in these plans. For instance, private sector plans – employers, unions, and individual plans – should use evidence to encourage people to make smart drug choices – drugs that work just as well and cost less, or drugs that work better. There are very expensive specialty drugs, some costing more than $1 million per person each year. Coverage for these medications should be based on evidence and reviewed by experts, on a case-by-case basis.
One single, nationally mandated pharmacare program would mean dissolving every existing provincially funded and employer-funded plan. It would likely mean one single, much smaller formulary (list of drugs), and would create opportunities for potential savings through bulk-buying. It would likely also create a large national bureaucracy and require a massive IT system to enroll and manage all Canadians and adjudicate their drug benefits. And as some suggest, it could threaten valuable pharmaceutical investment in this country. Why throw out the baby with the bathwater? Instead, why not keep what works and improve what doesn’t.
Furthermore, people likely don’t realize that a national pharmacare plan may cover less than their existing plan. For example, most public-sector unions receive 100-per-cent coverage of all prescription drugs on the market. To afford a plan that covers everyone, the people who have the best coverage would have to lose some coverage to make room for those who have none at all.
In that scenario, I envision a new patchwork of coverage as employers and unions try to negotiate supplemental drug plans to provide better coverage for their employees/plan members – in other words, more patchwork.
The real dilemma is that some people have nothing at all. Let’s focus on finding an innovative way to provide coverage to those who can’t afford their medications. Keep what works; refine what doesn’t.
The discussion around universal drug coverage is a good one, but let’s be smart and provide coverage for those who need it.
Helen Stevenson is a former Assistant Deputy Minister of Health who oversaw Ontario $4-billion drug program and the founder of Reformulary Group.
https://www.thestar.com/opinion/contributors/2018/03/29/pharmacare-focus-on-canadians-who-need-it-most.html
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