Social Policy in Ontario

Pharmacare is finally within reach

Posted on October 24, 2015 in Health Policy Context

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TheStar.com – Opinion/Commentary – A Toronto think-tank has produced a blueprint for a watered-down version of pharmacare that the new Liberal government might just go for.
Oct 23 2015.   By: Carol Goar, Star Columnist

Canada can — and should — move pharmacare from its perennial wish list to its under-construction file, says a new report from the C.D. Howe Institute. It is feasible right now to guarantee every Canadian access to medically necessary drugs, the authors contend.

Colin Busby, a senior policy analyst at the institute and Ake Blomqvist, a health economist at Carleton University, acknowledge their model won’t please everyone. It wouldn’t bring drug coverage into medicare. But it would break the political logjam that has obstructed progress for so long. It would bring down the “runaway cost” pharmaceuticals. And it would help low-income patients fill their prescriptions.

“In our view, recent proposals for a universal pharmacare plan under which governments would pay essentially all drug costs with only very limited patient charges, are not realistic,” Busby and Blomqvist argue. “We believe it is time to start moving toward a model that makes important inroads into the biggest shortcomings of the expensive and flawed system we have today.”

They point to five critical deficiencies:
– Too many low-income people can’t afford to fill their prescriptions.
– All Canadians pay too much for essential medications.
– The provinces have no common formulary, meaning the list of insured drugs varies across the country.
– People with rare diseases who need exceptionally expensive drugs have to beg the government or the manufacturer for help.
– There is no mechanism to improve the quality of prescribing by physicians.

The key to addressing all these problems, the authors say, is an increased role for the federal government in drug financing. Ottawa wouldn’t run the program or deliver the drugs; it would provide the cash and co-ordination to bring the existing provincial programs up to an acceptable national standard.

Fortuitously the report — written before this week’s election — dovetails nicely with the approach of Canada’s new Liberal government. Prime minister-designate Justin Trudeau has promised to “improve access to necessary prescription medications” and “work with the provinces and territories to buy drugs in bulk.” That isn’t quite pharmacare, but it is similar to what Busby and Blomqvist are recommending.

Under the C.D. Howe plan, Ottawa would top up health transfers to the provinces allowing them to ensure that drug costs do not exceed 3 per cent of family income anywhere in Canada. (For a single working parent with two children earning $30,000, the ceiling would be $900. For a two-earner family with two children with an income of $115,500 — the national average — the maximum would be $3,450).

All of the provinces currently have upper limits but they vary from 3 per cent to 12 per cent of family income. Ontario’s is 4 per cent.

Ottawa would become a partner in the Pan-Canadian Pharmaceutical Alliance launched by the premiers and territorial leaders in 2010 to bulk-purchase prescription drugs. This would increase its financial muscle — the federal government supplies medications to the prison population, First Nations, soldiers and veterans — when negotiating drug prices. It would also allow the federal government to play a co-ordinating role in creating a single national drug formulary, based on transparent clinical evidence of cost-effectiveness.

Ottawa would work with the provinces to design a national strategy for rare and high-cost diseases. Similarly it would help them build incentives into their drug plans for doctors to take responsibility for the cost of the prescriptions they write.

There would be no fundamental restructuring. A substantial share of drug costs would continue to be privately funded. The disruption would be minimal. Work could begin immediately.

Politically the stars are as well-aligned as they are likely to be. The premiers invited Ottawa to join the Pan-Canadian Pharmaceutical Alliance in June. Their health ministers agreed that Ottawa should play a role in improving access to prescription drugs and coverage for low-income Canadians. Trudeau has promised to negotiate a long-term health accord with the premiers and budgeted an additional $415 million for health care next year rising to $1 billion by 2019. And more than 90 per cent of Canadians support universal access to prescription drugs.

“Canadians need improvements to the existing arrangements,” Busby and Blomqvist point out. “What we propose would go a long toward achieving the same objectives as those of the federally funded universal drug plan.”
The question facing Canadians who have waited decades for a national publicly funded pharmacare program is: Do they settle for watered down version or hold out for the gold standard? They could wait a very long time.

< http://www.thestar.com/opinion/commentary/2015/10/23/pharmacare-is-finally-within-reach-goar.html >

Tags: budget, Health, ideology, mental Health, pharmaceutical, standard of living

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