A Step Toward Equality: Medication Coverage Within Medicare
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.
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.