A better fix than pharmacare

Two more milestones were reached on Canada’s long march toward national pharmacare over the last month. In June, the federal Advisory Council on the Implementation of National Pharmacare kicked off a public consultation with the release of a discussion paper. Meanwhile, health ministers from across the country met in Winnipeg to talk over the issue.

Public discussion about national pharmacare has not been well informed. It has been studied and recommended by the federal standing committee on health, but the evidence and expert testimony the committee has heard is onesided. Since the publicly funded advocacy campaign known as Pharmacare 2020 began ramping up political pressure five years ago, the only proposal considered so far has been the one most favoured by those whose financial interests or ideological preferences are tied to the public sector. The same folks are the source of the main assumptions being used to justify national pharmacare.

Take, for example, the claim that national pharmacare is needed because surveys have shown that many Canadians report that they cannot afford their medications. Pharmacare advocates have pounced on the surveys to claim that millions of Canadians have no drug plan. A new study published by the Canadian Health Policy Institute challenges this assumption.

The study examined prescription-drug-plan coverage across Canada to determine how many people were insured, under-insured or uninsured. It concluded that Canada had near-universal insurance coverage across the population for ordinary prescription drug costs and universal coverage for high drug costs.

The study found that in 2016 the total population of Canada was nearly 36.3 million. Almost 23.2 million people were covered by a private drug plan, while the remaining 13.1 million people were covered under public drug plans.

Of those Canadians in public drug plans, almost nine million were eligible for full coverage as a result of age, income, special disease, or Aboriginal status. This included 840,000 people who were eligible for full coverage under the federal non-insured health benefits program, which serves First Nations and Inuit clients. Plus, almost 8.2 million people were active claimants in provincial and territorial public drug plans. Nearly 4.1 million people were nonclaimants but remained eligible for safety-net coverage under public drug plans.

Every jurisdiction in Canada has publicly funded programs that cover high drug costs for people who don’t have a private drug plan and who don’t have status coverage for full benefits under a public drug plan. In some provinces people opt-in to the public drug plan by paying premiums. Generally, people become eligible for full public drug coverage after their out-of-pocket costs exceed a deductible or copayment.

Cost sharing for public drug benefits is income-adjusted. People in the lowest income deciles are eligible for coverage at zero or very low costs. People in the middle-income deciles face relatively moderate costsharing requirements, while people in the highest income deciles face the most significant exposure to cost, and even these costs are effectively capped between three and seven per cent of family income depending on the jurisdiction.

It was estimated that of the 4.1-million non-claimants that remained eligible for coverage under a public drug plan, more than 2.4-million people (in lower-family-income deciles) were potentially exposed to progressive income-adjusted annual deductibles, copayments, or premiums of up to $2,000 per family. For over one million people (in middle-family-income deciles) cost-sharing limits ranged between $2,000 and $5,000 per family. And almost 600,000 people (in the highest family income decile) were potentially exposed to costs of more than $5,000 per family.

Pharmacare’s advocates have misrepresented surveys of Canadians reporting cost-related reasons for not taking their prescribed medication, suggesting these mean that many people are not covered under any prescription drug plan. Those survey results are best explained by exposure to cost sharing under existing public drug plans. Simply forcing the entire population into a new national pharmacare plan is not a remedy for reducing out-of-pocket drug costs. It is easier and less expensive to adjust the cost-sharing criteria for existing public drug plan benefits.

ADVOCATES HAVE MISREPRESENTED SURVEYS REPORTING COST-RELATED REASONS FOR CANADIANS NOT TAKING THEIR MEDICATION.