New government, new hope for pharmacare

Health-care advocates are calling for prescription drug cost reform after nine years of inaction under the previous Conservative government.

In a mandate letter Prime Minister Justin Trudeau has instructed new Health Minister Jane Philpott to look at ways of improving access to prescription drugs.

“This will include joining with provincial and territorial governments to buy drugs in bulk,” he wrote. “[And] reducing the cost Canadian governments pay for these drugs, making them more affordable for Canadians, and exploring the need for a national formulary.”

For advocates, this means much-needed prescription drug reform is now front and centre with the new government even if the details are vague.

“Everyone understands that we as a country need to have a better handle on the access and cost of our prescription drugs,” says Linda Silas, president of the Canadian Federation of Nurses Unions (CFNU). “The only solution is a pharmacare program.”

Canada is one of the only western countries without a national plan for prescription drugs despite having a socialized health-care system. Most European Union member countries have national drug programs, meaning the state pays for most of the cost.

In Canada, the provinces will cover drug costs for seniors and the disabled as well as medications used during a stay in hospital.  Beyond that, patients have to pay out of pocket or depend on a patchwork of private health insurance plans. Some people have no insurance benefits at all and often balk at the cost of prescribed medications.

Canada is one of the only western countries without a national plan for prescription drugs despite having a socialized health-care system.—

“Six per cent of hospitalizations in Canada are with patients who are non-adhering to their prescriptions drugs,” Silas says.  “So either they can’t afford [them] or they are not taking [them] properly.”

Recent poll data illustrates what Silas is saying.  Twenty-three per cent of those surveyed by pollster Angus Reid last summer said they or someone in their household had taken drastic steps to save money on medication in the previous 12 months. This includes skipping or splitting pills to make the medication last longer. Some respondents even said they didn’t bother to fill or renew the prescription because of the cost.

Silas says a national pharmacare program should cover 100 per cent of medication costs.  She also says she has received commitments from several provinces to push for it at the next health-care accord meetings.

“If we agree the health-care system is [part] of the fabric of our country and we agree being sick and receiving care [should not be] based on your pocketbook, then we have to guarantee this for the long term,” she says. “We expect this government to be able to do this.”

This is not the first time pharmacare has been discussed.  When the health-care system was first established in the 1960s, governments considered adding prescription drug coverage, but ended up not including it because they thought the private insurance companies could handle it better.

Fast forward to the Romanow commission of 2002 and attitudes had changed: it was recommended that a national plan be put in place as soon as possible. But then the Conservatives came to power in 2006.

“They shut down this strategy, so for the last ten years nothing was done,” says Marc-André Gagnon, a Carleton University professor who studies health policy. “What we saw in the meantime was the provinces realizing this was not working.”

This led to the provinces banding together to purchase bulk quantities of drugs in order to reduce costs, but drug costs remain prohibitive for many uninsured Canadians.

As to what kind of pharmacare plan should be put in place, Gagnon cautions against “the open bar” system used in the United States for seniors. The government subsidizes the costs of drugs for the users but pays the full price to the pharmaceutical companies.  This is an expensive way of acquiring drugs for the population and does not take advantage of the bulk-buying power of governments, he says.

“This is exactly what we do not want and do not need,” he says. “If you want to promote greater quality . . . if you want to promote a more rational use of medication, it’s by providing access [for] those who don’t have it.”

Doctors overprescribing medications such as antibiotics have increased costs for governments.  Any future pharmacare system would have to include rules for curbing this type of behaviour, he says.

Dealing with the pharmaceutical companies may prove to be the biggest challenge for pharmacare, he adds.

“The other thing is negotiating in a consistent way to ensure you always get value for money,” he says.  “If you purchase drugs at any price . . . then you’re providing a huge incentive [for them] to sell you anything at any price.”

Gagnon adds the change in government has opened the door to major reform even though the Liberals did not make any firm commitments during the election.

“Universal pharmacare could mean very significant savings for Canadians,” he says. “What you’re not paying for in private premiums now you will need to pay more in additional taxes . . . but people do not like paying taxes and that could be one of the main obstacles.”

Gagnon says it will take some time and work, but reform is possible.

“It would be difficult to make the system worse than we have right now,” he says.

The change in government has also caught the attention of health advocates on the front lines of the system. Scott Wolfe, of the Canadian Association of Community Health Centres (CACHC), says the change in tone from the Trudeau government is welcome.

“It would be difficult to make the system worse than we have right now.”— Marc-André Gagnon

“We’ve been talking about this [pharmacare] forever,” he says. “It’s just a matter of negotiating the details of something like this.”

Wolfe says his members support a model where most of the drug costs are carried by the government.  He adds it is important to build a system that is tailor-made for Canada.

“It would do no one any good to just adapt or apply something from another jurisdiction without looking at the field that we’re trying to transplant that into,” he says. “This issue has been researched ad nauseam. There is some amazing academic work on this file.”

Wolfe also says he’s upbeat about the future of pharmacare in Canada.

“Together . . . I do believe we can figure this out in the next couple of years,” he says. “There is absolutely nothing preventing us from moving forward.”