READY FOR UNIVERSAL PHARMACARE?
MY SON, who has taken a few philosophy courses at university, recently shared a classic ethics problem with me. In the Trolley Problem, a runaway trolley carriage speeds down a track toward five people tied to its rails. You can throw a switch to divert the trolley to another track. But if you do, one person on the other track will be struck and killed.
For simplicity’s sake, there are only two choices:
1 Do nothing, and the runaway trolley kills the five people on the main track.
2 Flip the switch and divert the trolley onto the side track, where it will kill one person.
I’m grateful I can leave this decision to students of ethics. But the reality is that we or at least our governments make thorny ethical decisions like this every day.
Take the example of Strensiq, a drug that treats hypophosphatasia (HPP), a rare genetic disorder involving abnormal bone development that is severely debilitating in children or adults and fatal in infants.
A drug trial of 11 children with HPP delivered miraculous-sounding results. As children’s bones hardened, they began crawling, taking tentative steps or walking.
So how does a feel-good story become a trolley problem? It comes down to costs. An annual prescription for Strensiq can cost $500,000 and reach $1 million, and it must be taken indefinitely to prevent symptoms from returning.
Earlier this year, the alliance that negotiates drug prices for Ottawa and the provinces agreed to fund Strensiq for those who begin taking the drug before they reach 18, noting that evidence is not strong enough to support paying for treatment starting later in life.
As fewer than 100 people in Canada have HPP, approval of this drug won’t break the bank. But the decision opens the door to funding other high-cost medications. And that means tough decisions will have to be made.
It is possible for governments to get elected by promising more services in exchange for higher taxes, but it’s not an easy sell. Instead, money spent on certain programs, whether improved transit or more long-term care beds means fewer dollars available to spend elsewhere.
There’s no question that investing in high-cost drugs saves lives and improves quality of living, but the ethical question remains: is this the best use of these funds?
The difficulty in making these decisions is likely one reason Canada, alone among all countries with universal health care, lacks universal pharmacare. As of March 31, 2016, there were 10,946 unique drugs approved for sale by Health Canada; no one is suggesting that even the most robust of pharmacare programs would cover all of them.
But failing to introduce pharmacare is causing real harm now. According to a July 2017 survey of our members, eight per cent have considerable or extreme difficulty financing their medications, while 25 per cent have some difficulty. In all, six per cent of CARP members reported not filling a prescription in the past two years due to cost. Implementing pharmacare means no one has to choose between food, shelter and medication. It also means policy setters have to say no to drugs where they believe benefits do not justify costs.
Pharmacare appears to be on the agenda once again. At the time of writing, Ontario is in election mode: the NDP have committed to pharmacare for all ages while the Liberal party would extend their current program (which provides free medications to those under 18) to those who are 65 and older. The Ontario Progressive Conservatives have so far been silent as to whether they would retain, expand or eliminate current drug coverage programs.
In its recent budget, the federal government committed to a national dialogue on implementing pharmacare, and the House of Commons Health Committee recently issued a report recommending the creation of a single-payer, publicly funded prescription drug coverage program for all Canadians.
If we want our government to introduce universal pharmacare and ensure medication is accessible, affordable and appropriate for all Canadians, we must have the government’s back when they analyze drug costs and benefits and make the tough decisions that will make pharmacare work. For more information, go to carp.ca/ pharmacare.
Wanda Morris is VP of Advocacy at CARP and writes a weekly Post Media column “Grey Matters.” You can find them at CARP.ca/blogs.
In a July poll of CARP members, 86 per cent agree or strongly agree that the same drugs should be covered by provincial drug plans across Canada