Univer­sal Phar­ma­care: Pre­scrib­ing a So­lu­tion

Policy - - Before The Bell | From The Editor - BY DALE SMITH

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.”

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