A Step To­ward Equal­ity: Med­i­ca­tion Cov­er­age Within Medi­care

The Gulf News (Port aux Basques) - - Editorial - BY NATASHA MUR­PHY Natasha Mur­phy is cur­rently a Mas­ter of Pub­lic Health stu­dent at Memo­rial Univer­sity. She is pas­sion­ate about medicine, health pro­mo­tion and the equal­ity and uni­ver­sal­ity of health care. Natasha was born and raised in Cor­ner Brook and re

We have all been pre­scribed med­i­ca­tion at one point or an­other in our lives. Many of us know how much in­sur­ance costs. Some of us know just how much med­i­ca­tion can cost if it is not cov­ered by, or is only par­tially cov­ered by in­sur­ance. There have been talks on whether or not Canada’s medi­care sys­tem should in­clude med­i­ca­tion cov­er­age. Like my­self, many peo­ple firmly be­lieve that med­i­ca­tion cov­er­age should be in­cluded. How can we say that our health­care sys­tem is “uni­ver­sally ac­ces­si­ble” if there are those of us who can­not af­ford the nec­es­sary med­i­ca­tion re­quired?

The ma­jor rea­sons the gov­ern­ment has not moved to cover med­i­ca­tion through medi­care are the prac­ti­cal con­sid­er­a­tions and lo­gis­ti­cal chal­lenges that would be en­coun­tered1. One chal­lenge that would be faced is the need to cre­ate a na­tional “ev­i­dence-based for­mu­lary” (a for­mu­lary is a list of med­i­ca­tions that are ac­cept­able to pre­scribe) An­other chal­lenge would be that “prices and sup­ply con­tracts need to be ne­go­ti­ated” And, fi­nally, the cost of med­i­ca­tions would be cov­ered through pub­lic plans (most likely lead­ing to an in­crease in taxes)1. How­ever, I would con­sider these chal­lenges small when com­pared to the ben­e­fits that this cov­er­age would of­fer us Cana­di­ans.

Be­fore call­ing for a re­form of med­i­ca­tion cov­er­age it is im­por­tant to un­der­stand the cur­rent sys­tem. Any med­i­ca­tion re­ceived by a pa­tient while they are in a hos­pi­tal is com­pletely cov­ered by medi­care2. Whereas only a small por­tion of the med­i­ca­tion re­ceived through the ful­fil­ment of a pre­scrip­tion at a lo­cal phar­macy is cov­ered2. The pub­lic plans that are of­fered vary from prov­ince to prov­ince and their cov­er­age is based on a va­ri­ety of fac­tors such as in­come or age2.

These pub­lic plans only cover 42% of the over­all costs of med­i­ca­tion within Canada2. Pri­vate in­sur­ance cov­ers 36% of med­i­ca­tion costs, but this in­sur­ance is not re­quired to be car­ried by em­ploy­ers (ex­cept in Que­bec where an em­ployer is re­quired to pro­vide in­sur­ance to “el­i­gi­ble em­ploy­ees”) Most pri­vate in­sur­ance is gained through ex­tended work ben­e­fits (these in­sur­ances are usu­ally only seen in em­ploy­ees who are full-time and em­ployed in larger in­sti­tu­tions)

The costs as­so­ci­ated with the cur­rent med­i­ca­tion sys­tem are dis­pro­por­tion­ally af­fect­ing those of a lower in­come. Cost can be a ma­jor bar­rier for some of us in at­tain­ing our nec­es­sary med­i­ca­tion3. It has been shown that those of us with­out in­sur­ance are “less likely to fill pre­scrip­tions than those with in­sur­ance” Even for those of us with in­sur­ance the small costs as­so­ci­ated with med­i­ca­tion (such as dis­pens­ing fees) can pre­vent some of us from be­ing able to af­ford these nec­es­sary med­i­ca­tions3.

One tenth of Cana­di­ans are un­able to take their es­sen­tial med­i­ca­tions due to the as­so­ci­ated costs2. When peo­ple do not see an in­stant ben­e­fit from tak­ing a pre­ven­tive med­i­ca­tion (like a med­i­ca­tion that de­creases the prob­a­bil­ity of hav­ing a stroke) they fre­quently elect to stop us­ing that med­i­ca­tion when con­fronted with the costs2. But, when they do this they of­ten end up us­ing other health ser­vices. This tends to cost the medi­care sys­tem more than the med­i­ca­tion ever would have2. This ex­act is­sue is es­ti­mated to cost the health care sys­tem “be­tween $1 bil­lion and $9 bil­lion an­nu­ally”

Each Cana­dian prov­ince has many dif­fer­ent pri­vate in­sur­ances and pub­lic plans that pay for med­i­ca­tion3. But, many of these in­sur­ances/plans still have im­me­di­ate costs through “de­ductibles, co-pay­ments and co-in­sur­ances” When other coun­tries that cover med­i­ca­tion, charg­ing their peo­ple very lit­tle or noth­ing, were com­pared it was de­ter­mined that if Canada were to pro­vide this cov­er­age it would lead to an in­crease in per­for­mance in all “key phar­ma­care pol­icy goals” When con­sid­er­ing these coun­tries, it was also de­ter­mined that their cit­i­zens have bet­ter ac­cess to med­i­ca­tion and “greater fi­nan­cial pro­tec­tion” at a no­tably de­creased cost com­pared to our prov­inces3.

One of the ma­jor ar­gu­ments against med­i­ca­tion be­ing cov­ered through medi­care is that it will cost Cana­di­ans more than it would save them. In 2015, Cana­di­ans filled roughly “568.4 mil­lion pre­scrip­tions” in phar­ma­cies through­out the coun­try1. This gives a to­tal price tag of $10.8 bil­lion1. Of these pre­scrip­tions only 377.5 mil­lion were cov­ered un­der the pub­lic plans, con­tribut­ing only $4.27 bil­lion to the to­tal price1. Adding es­sen­tial med­i­ca­tion cov­er­age to our medi­care sys­tem would only cost the gov­ern­ment roughly $1.23 bil­lion a year1. How­ever, it would save us and pri­vate in­sur­ances $4.27 bil­lion a year1.

By cov­er­ing med­i­ca­tion in medi­care we will be in­creas­ing the equal­ity of our health care sys­tem and en­sur­ing that price is not a bar­rier to fel­low Cana­di­ans when fill­ing pre­scrip­tions for nec­es­sary med­i­ca­tions. Adding this cov­er­age will lead to us Cana­di­ans sav­ing bil­lions of dol­lars ev­ery sin­gle year, whereas the gov­ern­ment only need pay a bil­lion and a half1. So, I ask the gov­ern­ment to take a step to­ward equal­ity and uni­ver­sal­ity and cover ev­ery Cana­di­ans med­i­ca­tion through medi­care.

Ref­er­ence List

1. Mor­gan SG, Li W, Yau B, Per­saud N. Es­ti­mated ef­fects of adding univer­sal pub­lic cov­er­age of an es­sen­tial medicines list to ex­ist­ing pub­lic drug plans in Canada. CMAJ. 2017, 8(189): E295-E302. https:// www.ncbi.nlm.nih.gov/pmc/ar­ti­cles/PMC5325730/. Ac­cessed Oc­to­ber 24, 2017.

2. Mor­gan SG, Mar­tin D, Gagnon M, Mintzes B, Daw JR, Lexchin J. Phar­ma­care 2020: the fu­ture of drug cov­er­age in Canada. Phar­ma­ceu­ti­cal Pol­icy Re­search Col­lab­o­ra­tion. 2015. http://phar­ma­care2020. ca/as­sets/pdf/The_Fu­ture_of_Drug_Cover­age_in_ Canada.pdf. Ac­cessed Oc­to­ber 24, 2015.

3. Mor­gan SG, Daw, JR, Law MR. Re­think­ing phar­ma­care in Canada. Com­men­tary – C.D. Howe In­sti­tute. 2013, 384: 2-24. http://www.deslib­ris.ca.qe2aproxy.mun.ca/ID/238131. Ac­cessed Oc­to­ber 24, 2017.

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