Panel calls for $15.3-bil­lion pharmacare plan

The Globe and Mail (Ottawa/Quebec Edition) - - FRONT PAGE - HEALTH REPORTER

Fed­eral ad­vi­sory coun­cil’s report says universal, sin­gle-payer pro­gram would sig­nif­i­cantly cut per-capita spend­ing on pre­scrip­tions

Canada should adopt a universal, sin­gle-payer public pharmacare pro­gram that does for prescripti­on drugs what medi­care did for ser­vices pro­vided in hos­pi­tals and doc­tors’ of­fices, ac­cord­ing to a new ad­vi­sory coun­cil report.

The Lib­er­als – who es­tab­lished the pharmacare coun­cil in their 2018 bud­get – wouldn’t im­me­di­ately com­mit to put­ting the blue­print into their platform. But with a fed­eral elec­tion only four months away, the pro­posed plan pro­vides them with a sig­na­ture pol­icy if they choose to run on it.

The coun­cil’s rec­om­men­da­tions would mean a rad­i­cal over­haul of the coun­try’s patch­work ap­proach to pay­ing for pre­scrip­tions – one the report pre­dicts would cost gov­ern­ments an ad­di­tional $15.3-bil­lion an­nu­ally by the time the plan is fully im­ple­mented in 2027.

How­ever, the coun­cil pre­dicted that a sin­gle-payer plan would sig­nif­i­cantly re­duce Canada’s per capita prescripti­on-drug spend­ing, which is among the high­est in the world.

“I think this is a good time for us to show courage and bold­ness and do some na­tion build­ing,” said Eric Hoskins, the for­mer On­tario health min­is­ter who chaired the ad­vi­sory panel. “The price is too high, frankly, not to do any­thing.”

As Dr. Hoskins and his col­leagues en­vi­sion it, na­tional pharmacare would be im­ple­mented grad­u­ally, with a new na­tional drug agency ne­go­ti­at­ing prices on a “care­fully cho­sen list of es­sen­tial medicines” to be in­cluded in the first phase of the plan, be­gin­ning Jan. 1, 2022. The ini­tial list would cover most ma­jor con­di­tions and rep­re­sent about half of all pre­scrip­tions. The drug agency would then aim to ne­go­ti­ate fur­ther pric­ing and sup­ply ar­range­ments for more drugs, with an eye to having a com­pre­hen­sive master list, or for­mu­lary, in place by 2027.

The drugs on the list would be vir­tu­ally free for all Cana­di­ans, with the ex­cep­tion of a $2 co-pay for drugs on the es­sen­tial list, and a $5 co-pay for drugs on the ex­panded list.

There would be a co-pay limit of $100 per year a house­hold. The poor­est Cana­di­ans would be ex­empt from co-pays.

The plan also calls for a na­tional strat­egy on drugs for rare dis­eases, whose as­tro­nomic prices are put­ting pres­sure on pri­vate and public drug plans.

Right now, Cana­di­ans pay for prescripti­on drugs in one of three ways: through ex­tended work­place and pri­vately pur­chased health plans; through gov­ern­ment drug plans, which are of­ten re­served for the poor, for se­niors and for those with cat­a­stroph­i­cally high drug bills; or out of their own pock­ets.

The pharmacare plan laid out in Wed­nes­day’s report is still a long way from be­ing en­acted. If Prime Min­is­ter Justin Trudeau’s gov­ern­ment were to em­brace the rec­om­men­da­tions and win re-elec­tion in Oc­to­ber, it would still have to per­suade pro­vin­cial and ter­ri­to­rial gov­ern­ments to take part.

The report rec­om­mends that Ottawa en­tice the pre­miers with a new, ded­i­cated fis­cal trans­fer pay­ment for pharmacare, one that would cover all costs over and above what pro­vin­cial and ter­ri­to­rial gov­ern­ments are al­ready spend­ing on their public drug plans. The report says a unan­i­mous agree­ment would not be nec­es­sary off the bat; provinces could join in over time the way they did as medi­care was founded and ex­panded more than 50 years ago.

Fed­eral Health Min­is­ter Ginette Petit­pas Tay­lor, who said she was still re­view­ing the report, would not im­me­di­ately com­mit to pay­ing the full in­cre­men­tal cost of a na­tional pharmacare plan. But she ac­knowl­edged that Ottawa would not be able to bring the pre­miers to the table with­out first pledg­ing some money for it.

“We cer­tainly don’t ex­pect provinces to foot the bill here,” Ms. Petit­pas Tay­lor said. “If we want to put in place a na­tional pharmacare pro­gram, the fed­eral gov­ern­ment has to play a lead­er­ship role.”

If the na­tional ad­vi­sory coun­cil’s plan is en­acted, it could de­liver a sig­nif­i­cant blow to the coun­try’s pri­vate-in­sur­ance and phar­ma­ceu­ti­cal in­dus­tries, both of which have ar­gued that Cana­di­ans would be bet­ter off if Ottawa bol­stered the ex­ist­ing pri­vate-public sys­tem in­stead of blow­ing it up.

Stephen Frank, pres­i­dent of the Cana­dian Life and Health In­sur­ance As­so­ci­a­tion, warned that Cana­di­ans who are happy with their ex­ist­ing pri­vate ben­e­fit plans could wind up los­ing ac­cess to some of their med­i­ca­tions un­der a purely public sys­tem. The as­so­ci­a­tion, which rep­re­sents pri­vate in­sur­ance companies, said that ap­prox­i­mately 7.7 mil­lion Cana­di­ans are tak­ing pri­vately cov­ered drugs for can­cer, de­pres­sion, di­a­betes, pain and other con­di­tions that are not listed on their provinces’ ex­ist­ing public drug plans.

“For the vast ma­jor­ity of Cana­di­ans – some 25 mil­lion of them – with pri­vate coverage, they al­ready have ex­cel­lent plans,” Mr. Frank said. “Those are at risk if you move to a first-payer fed­eral sys­tem.”

Like Mr. Frank, Mar­i­lyn Gladu, the Con­ser­va­tive health critic, ar­gued it would be safer and far less ex­pen­sive to plug the gaps in the ex­ist­ing sys­tem. “With a $15-bil­lion price tag on top of a $20-bil­lion deficit, the only way the gov­ern­ment can pay for that is rais­ing taxes,” she said. “I don’t think that’s a good idea.”

Dr. Hoskins said that a fill-the-gaps ap­proach would not achieve any­where near the sav­ings of a na­tional, public pro­gram that could har­ness the buy­ing power of all Cana­di­ans to ne­go­ti­ate lower drug prices, en­cour­age wider use of cheaper gener­ics and limit coverage to med­i­ca­tions with the best prices and ev­i­dence of ef­fi­cacy.

By 2022, to­tal spend­ing on pre­scrip­tions drugs would be $300-mil­lion lower un­der the first phase of na­tional pharmacare than if the sta­tus quo con­tin­ued, the report pre­dicted. That es­ti­mate would rise to $5-bil­lion by 2027.

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