NAFTA talks threaten Canada’s uni­ver­sal phar­ma­care

The Guardian (Charlottetown) - - EDITORIAL - BY RUTH LOPERT AND STEVE MOR­GAN Ruth Lopert is an ad­junct pro­fes­sor in the De­part­ment of Health Pol­icy & Man­age­ment at Ge­orge Wash­ing­ton Univer­sity. Steve Mor­gan is an ex­pert ad­vi­sor with Ev­i­denceNet­work.ca

A “mod­ern­ized NAFTA” has sig­nif­i­cant im­pli­ca­tions for many sec­tors of the econ­omy — and health care is one of them. What’s at stake? Cana­di­ans’ right to uni­ver­sal ac­cess to af­ford­able medicines.

When ne­go­ti­at­ing with the U.S. and Mex­ico, Canadian trade and health of­fi­cials would be well ad­vised to be mind­ful of two things.

First, U.S. trade ne­go­tia­tors have long favoured the in­ter­ests of phar­ma­ceu­ti­cal man­u­fac­tur­ers. The U.S. trade agenda is heav­ily in­flu­enced by phar­ma­ceu­ti­cal in­dus­try ad­vi­sors and lob­by­ists with lit­tle or no in­put from op­pos­ing in­dus­tries, health pro­fes­sion­als or the pub­lic.

Canada has come up short in past trade ne­go­ti­a­tions where pre­scrip­tion medicines are con­cerned.

In the 1980s, the U.S. phar­ma­ceu­ti­cal in­dus­try suc­cess­fully lob­bied the U.S. gov­ern­ment to make the elim­i­na­tion of early generic drug com­pe­ti­tion in Canada part of the Canada-U.S. free trade agree­ment. In the 1990s, it made the dis­man­tling of poli­cies favour­ing Canadian drug man­u­fac­tur­ers part of the orig­i­nal NAFTA deal.

In re-ne­go­ti­at­ing NAFTA, ex­perts ex­pect the U.S. to press Canada for longer mo­nop­o­lies on patented medicines. This is in­tended to de­lay com­pe­ti­tion from low-cost generic medicines and would sig­nif­i­cantly in­crease costs for Cana­di­ans -- with­out any ben­e­fits.

But changes in in­tel­lec­tual prop­erty rights for medicines may not be as bad for Canada as other ob­jec­tives the U.S. will likely pur­sue on be­half of the phar­ma­ceu­ti­cal in­dus­try in NAFTA re-ne­go­ti­a­tions. In­ter­na­tional ex­pe­ri­ence sug­gests the U.S. will also at­tempt to con­strain the phar­ma­ceu­ti­cal pric­ing and cov­er­age poli­cies of its trad­ing part­ners.

Australia’s ex­pe­ri­ence is note­wor­thy. In 2003, the U.S. en­tered Australia-U.S. Free Trade Agree­ment (AUSFTA) ne­go­ti­a­tions with an ex­plicit man­date to seek “the elim­i­na­tion of gov­ern­ment mea­sures such as price con­trols and ref­er­ence pric­ing which deny full mar­ket ac­cess for United States prod­ucts.”

The phar­ma­ceu­ti­cal in­dus­try typ­i­cally views such cost-ef­fec­tive­ness con­sid­er­a­tions as “non­tar­iff bar­ri­ers” to mar­kets.

The Australian gov­ern­ment suc­cess­fully de­fended its uni­ver­sal pub­lic drug plan and its right to use rig­or­ous, ev­i­dence-based pro­cesses to de­ter­mine which medicines would be cov­ered and which would not.

Canadian ne­go­tia­tors should also be mind­ful of the job of Canadian health and trade of­fi­cials to de­fend not only the ex­ist­ing pub­lic health care sys­tem, they must also rec­og­nize and pro­tect Canada’s as­pi­ra­tions to­ward a bet­ter sys­tem in the fu­ture.

Canada is the only high-in­come coun­try with a uni­ver­sal health care pro­gram that doesn’t in­clude uni­ver­sal cov­er­age of pre­scrip­tion drugs. To­day, more than 60 years af­ter such a plan was orig­i­nally pro­posed for Canada, our prov­inces are fi­nally de­mand­ing it from the fed­eral gov­ern­ment.

If Canada is to have uni­ver­sal phar­ma­care any­time in its fu­ture, NAFTA re-ne­go­ti­a­tions must pri­or­i­tize the pro­tec­tion of ev­i­dence-based cov­er­age de­ci­sion-mak­ing and price ne­go­ti­a­tions that will be essen­tial to cre­ate a sys­tem that func­tions ef­fec­tively and sus­tain­ably.

Canadian ne­go­tia­tors must be ready to de­flect the tired rhetoric of U.S. trade ne­go­tia­tors and the phar­ma­ceu­ti­cal in­dus­try lobby, who will likely claim that elim­i­nat­ing value as­sess­ments and price ne­go­ti­a­tions will some­how mag­i­cally “im­prove ac­cess.”

In re­al­ity, the only way to en­sure that all Cana­di­ans have af­ford­able ac­cess to gen­uine phar­ma­ceu­ti­cal in­no­va­tions is to as­sess each drug ac­cord­ing to cri­te­ria that are rig­or­ous but fair to ev­ery man­u­fac­turer.

It is al­most cer­tain that the U.S. will pur­sue pro­vi­sions in a re-ne­go­ti­ated NAFTA that will un­der­mine both cur­rent and fu­ture ef­forts to pro­vide uni­ver­sal cov­er­age of medicines on the ba­sis of rig­or­ous as­sess­ments of com­par­a­tive clin­i­cal- and cost­ef­fec­tive­ness. Canada must be pre­pared to fight this.

Re­mem­ber that, in its ef­forts to re­peal Oba­macare, the cur­rent U.S. ad­min­is­tra­tion is will­ing to drive up health care costs while al­low­ing tens of mil­lions of Amer­i­cans to lose their health in­sur­ance. If it’s will­ing to do that to its own cit­i­zens, this U.S. Gov­ern­ment will likely also at­tempt to co­erce Canada to do the same to Cana­di­ans by way of NAFTA pro­vi­sions that would pre­vent the im­ple­men­ta­tion of an eq­ui­table and sus­tain­able uni­ver­sal phar­ma­care sys­tem.

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