Getting it right on Pharmacare
It has often been cited that Canada is the only major western country with a national Medicare system that does not include some version of a national public drug plan. Last year, more than 620 million prescriptions were filled by Canadians. Pharmaceuticals are the most frequently used therapeutic intervention used by clinicians to treat people and yet somehow pharmaceuticals have not yet been fully integrated into the Canadian health system.
Innovative Medicines Canada has been advocating for the creation of a pan-Canadian framework to support comprehensive access to pharmaceuticals for all Canadians.To inform this dialogue, we put forwardthree principles that we believe should form the basis of any sustainable national pharmacare program.
Patient-centric
First and foremost, we believe that all Canadians should have timely access to the choice of medicines they need, regardless of income, age, or postal code.
While there is robust private and public drug coverage in Canada, we recognize that these systems are not perfect and that some Canadians are falling through the cracks, either because they have no coverage, or they have insufficient coverage. Fortunately, according to a recent analysis by the Conference Board of Canada, over 98% of Canadians are in fact eligible for some form of prescription drug coverage. However, nearly 10% of Canadians (P.6 million) Canadians are not taking advantage of public drug coverage for which they are eligible.
Reasons for this include a lack of awareness of their eligibility and out-of-pocket costs.
A made-in-Canada pharmacare program should focus on meeting the needs of those vulnerable Canadians who need medicines but are either not eligible for any coverage or have insufficient coverage.
Value and Sustainability
Canadians are generally supportive of the government’s decision to examine ways to help make medicines affordable for all Canadians, according to an Abacus data survey released in September[1]. When asked what factors should be considered in developing a national policy, 94% of respondents indicated the need to keep costs low for taxpayersand 90% did not want group coverage to be put at risk of cancellation.
We agree with Canadians that any pharmacare option must be both fiscally responsible and practical to implement in the context of Canada’s mixed public and private insurance framework.
System Responsiveness
Pharmacare options should reflect diverse and evolving patient needs and be responsive to technological change through the timely adoption of innovation. Medicines have the potential to save lives or enhance a patient’s quality of life and save precious healthcare dollars. For example, a study of six classes of innovative medicines in Ontario found that the cost of the new medicines was offset by reductions in the use of other healthcare resources such as physicians and hospitals, and reduced productivity lossesin the workplace.
A national pharmacare system does not have to be an all-or-nothing proposition. Canadians don’t have to choose between the current dual-payer system or a single-payer universal pharmacare program funded entirely by government. By addressing the needs of Canadians who don’t have coverage or are underinsured, we can create a sustainable national pharmacare program that ensures that patients receive the best standard of care and have timely access to necessary medicines for years to come.
Pamela Fralick is president of Innovative Medicines Canada
Contributed to the Sixth Estate – The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Sixth Estate.
Nearly 10% of Canadians (3.6 million) are not taking advantage of public drug coverage for which they are eligible.”