National Pharmacare Makes Sense, So Why Don’t We Have It?

Every developed country in the world with universal healthcare also provides universal coverage of prescription drugs. Well, except Canada.

A national public drug plan, or Pharmacare as it’s more commonly called, has been in the works since the 1960s, when the Royal Commission on Health Services recommended its introduction following that of Medicare. Yet not much has happened since, at least as far as concrete action is concerned. While the 2002 Romanow Commission argued for a national prescription drugs plan, the state of Pharmacare in Canada differs little from the original debates more than 50 years ago.

The numbers speak for themselves. One in every 10 Canadians cannot afford the drugs they are prescribed, and only a third of Canadians are covered by public drug plans, the latter varying greatly from province to province. The vast majority of Canadians are covered through their workplace by private insurance plans, of which less than half covered 100 percent of drug costs. And you’re left without any coverage should you be laid off of work. What’s worse, 10 percent of the population isn’t covered whatsoever.

The finances also favor the introduction of national Pharmacare. Marc-André Gagnon, associate professor at Carleton University, found that a properly regulated national public drug plan would result in a 41 percent reduction in costs, or $11 billion in savings. Our current patchwork of private and public plans has proven to be far more costly than other countries’ public plans: Canada pays the highest price for generics in the world, and the second-highest for on-patent drugs.

With such alarming lack of proper coverage and a financially inefficient system, what’s in the way of implementing a national public drug plan?

The first step is to change how we purchase our drugs. Currently, deals with pharmaceutical companies are made at the provincial level, which results in varying coverage and drug prices. Globe and Mail journalist André Picard noted that the same out-of-hospital drug cancer treatment will cost you nothing in Nunavut, $3,000 in BC and $20,000 in PEI. Sadly, these numbers make sense. It’s unlikely to imagine that a tiny province of less than 150,000 people can ever negotiate with pharmaceutical giants for deals on drugs. Deals made by private insurance companies only further fragment and undermine our nation’s drug plans.

To solve this, national Pharmacare advocate Adrienne Silnicki, national coordinator for the Canadian Health Coalition (CHC) says we need to buy as one country. Only then will we obtain the bargaining power needed to repeatedly reduce drug prices.

“[Pharmaceuticals] want access to the full market so if we were to negotiate as one country right away that would give us instant savings,” says Silnicki.

Another requirement and by-product of such an initiative is an independent drug testing agency. Pharmaceutical companies currently pay Health Canada half the total cost for the drug approval process, resulting in approving drugs too quickly without adequate testing procedures for both safety and cost-effectiveness. The possibility for bias is quite obvious. Furthermore, the threshold for drug approval is so low that a new drug only has to be better than a placebo to be introduced into the market, not necessarily better than an existing drug. With an independent testing and approval board, the country can avoid buying newer, more expensive patented drugs that offer questionable advantage over the existing selection.

While some will argue for a “some drugs” initial approach to national Pharmacare, this too will get in the way of reducing drug prices. Pharmaceutical companies offering discounted prices on a set drug list allows them to raise the price of the excluded drugs to compensate for the dip in profit. This cost-shifting practice can be avoided with full commitment to introducing Pharmacare.

“When we talk about a national public drug plan we talk about a full, comprehensive, universal plan like our public healthcare system: it includes everybody, it’s without co-pays, ensures that everyone can access the medication they need,” said Silnicki.

The last hurdle lies here in Ottawa. The initiatives undertaken by Premiers and their respective provinces towards building a common drug list hasn’t been met by leadership and political power on behalf the federal government. Despite the aforementioned benefits of a national public drug plan, the Hill’s dedication to a cost-neutral program prevents the necessary start-up cost to implement this update to our public healthcare plan. Standing up to pharmaceutical giants and braving the initial cost certainly won’t be done overnight, but it’s about time we look further down the road and see the bigger picture.

“There definitely needs to be conversations across the scope to make sure we have a system that works for everyone, but we also need to recognize that there will be a loss of profit for some individuals. And that’s ok if it means everybody can access the medications that they need,” Silnicki concluded.