Universal Pharmacare: Prescribing a Solution
In its report to Parliament last April, the House of Commons Standing Committee on Health recommended a national, universal pharmacare program, a policy shift that would have the support — according to a 2015 Angus Reid poll — of an overwhelming 91 percent of Canadians. Before the Bell hosted a panel of experts to discuss the options currently under discussion, the costs involved, and the ongoing work of the Advisory Council on Implementation of National Pharmacare chaired by Dr. Eric Hoskins. Moderators David Akin and Shawn McCarthy welcomed their respective panels — on the politics and policy of the issue — to flesh things out.
On the politics, Peter Cleary, senior consultant with Santis Health and former senior aide to then-Health Minister Jane Philpott, said Canadians aren’t yet in a position to rank pharmacare versus other healthcare priorities because a detailed plan has not yet been presented. Cleary added that provinces have the ability to go their own way, but there are added complications if the federal government decides to exert some authority, particularly through a national formulary.
“I think that politicians are really uncomfortable with deciding what gets coverage and what doesn’t, and that’s at the crux of a national formulary, and that was in the mandate letter when I was in the minister’s office a couple of years ago and it continues to be,” said Cleary. “We’ll see if we get to the pharmacare piece because there’s a lot of other pieces that they haven’t touched yet.”
Corinne Pohlmann, senior vice-president of national affairs and partnerships with the Canadian Federation of Independent Business (CFIB), said that her organization represents business owners who rarely have drug coverage of their own. She said it’s an issue that the federal government can’t realistically do on its own.
“Any pharmacare programs that currently exist are provincial in scope — the problem is that it varies from province to province,” said Pohlmann. “You can’t move this forward without direct provincial involvement, and they’re probably going to have to deliver it regardless.”
L. Ian MacDonald, publisher and editor of Policy magazine, said that national pharmacare has been a perennial promise from political parties, there has been very little momentum, and there will be added complications with the new terms around intellectual property in the USMCA.
“The NDP have been working very hard in question period to make this intellectual property issue an Issue,” said MacDonald. “Whether they’ll succeed is another question.”
During the main panel on policy, Pamela Fralick, president of Innovative Medicines Canada, said that the whole-of-stakeholder approach needs to be front and centre as the pharmacare discussion evolves.
“That patient-centric view of the world is number one for us,” said Fralick. “We don’t exist if we don’t have patients, and care for them, and provide products that are useful.”
Fralick added the challenge for pharmacare tends to be implementation, which is what Dr.
Hoskins has been tasked to tackle by the federal government. Fralick pointed out that this is why Hoskins will report to both the health and finance ministers.
Janet Yale, president and CEO of the Arthritis Society (Canada), says the principle of pharmacare should be timely and equitable access to medically necessary treatments for all Canadians, irrespective of where they live.
“It turns out that with private plans, there is reasonable coverage across Canada, but public plans are another story,” said Yale. “We don’t see why you would take public money to replace private plans for the vast majority of Canadians that do have access to their medically necessary treatments. We want to avoid a race to the bottom.”
In Yale’s estimation, that means closing the gaps in the public system in order to best leverage scarce resources.
Joelle Walker, director of public affairs with the Canadian Pharmacists Association, says that pharmacists are already on the front line of managing drug plans, they can see where the gaps are in the system, and that the current system is not sustainable over the long term.
“There are a lot of areas that we haven’t focused on, including the appropriateness and utilization of medications,” said Walker. “A recent statistic around medication returns to pharmacies cited that in four provinces alone, it was about 400 tonnes of medications returned in 2017. People aren’t using their medications as prescribed.”
Walker says that this is where pharmacists can come in, to help better manage patients’ drug regimens.
Bill Casey, Liberal MP for Cumberand-Cholchester, Nova Scotia, and chair of the House of Commons Standing Committee on Health, said that the committee’s two-year study on pharmacare in Canada was a fascinating exercise.
“The consensus in the report is that we will have better healthcare at a considerably lower cost with a national pharmacare program, and that was absolute with healthcare providers,” said Casey.
Casey adds that the federal government current has six different drug programs, and provinces can have six to twelve programs each, meaning there is a considerable amount of overhead in administering them. Casey added that the Parliamentary Budget Officer conducted a study on behalf of the committee, which determined that the current nuebec program was probably the best model, though Yale countered that it still doesn’t meet all of the needs of patients.
“What we have doesn’t make sense to me,” said Casey. “If we have a national pharmacare program, we will have consistency in delivery.”