Canada might not have a national catastrophic drug program, but there are plenty of international models the federal government could look to should it ever decide to adopt one.
Canada is one of the only developed countries that doesn't have a national catastrophic program to prevent citizens who don't have insurance from spending exorbitant amounts of money on prescription drugs.
The United Kingdom is heralded as having one of the most comprehensive systems for orphan diseases to ensure that patients do not go without drugs or treatments.
"In most situations where there is a licensed therapy, most patients will eventually get the drug once they have a confirmed diagnosis," said Alastair Kent, director of Genetic Alliance UK, a national charity of patient organizations supporting those affected by genetic disorders.
Without such a system, Canadians must pay out-of-pocket for necessary medications, forcing many deep into debt while others risk bankruptcy to pay for drugs. Some simply go without medication, leading to serious health problems.
It's a black eye for a country that prides itself on universal health care, and medical experts have been calling for the creation of a comprehensive program for years.
In the United Kingdom, orphan conditions for which drugs are funded are typically defined as those that affect fewer than 500 people or require highly specialized procedures that are done fewer than 500 times each year, such as heart transplants.
The decisions on whether to finance particular medications are made by regional health organizations, which are part of the National Health Services. However, they must pay if the National Institute for Health and Clinical Excellence has ruled in favour of a drug or the Advisory Group for National Specialised Services, a national commissioning group, has recommended it.
For example, patients with Prader-Willi syndrome began receiving growth hormone almost nine years ago, after NICE determined that it was a "clinically and cost-effective way to treat children with growth hormone deficiency."
Although it would require a significant government investment, developing a Canadian catastrophic drug program wouldn't be difficult, considering the leading examples around the world and extensive reports written on the subject here, according to John Abbott, CEO of the Health Council of Canada.
"We have the knowledge. We know what other countries are doing. We take the best practices and apply them to Canada," he said. "The ability to do it is there."
The only thing that's missing, Mr. Abbott says, is political leadership to get the job done.
How it works: The government's Pharmaceutical Benefits Scheme subsidizes drug costs. Australian residents pay a maximum of about $33 for each prescription. Once an individual's drug costs reach about $1,300, out-of-pocket expenses are reduced to just a few dollars under a program known as the Pharmaceutical Benefits Scheme Safety Net.
The pros: All citizens have access to the drugs they need and won't be faced with high costs if they require expensive medications.
The cons: Widespread availability of drugs at very low costs helped fuel abuse of the system, with some people trying to buy more of their medication than they needed at one time so they would reach the "safety net" threshold quickly and pay lower costs. A new rule prevents a purchase from being added to an individual's safety-net threshold if a prescription for the same drug was filled fewer than 20 days earlier.
In The United States
How it works: Under Medicare Part D, beneficiaries pay a deductible and share the costs of drugs with the insurance program until the total amount reaches about $2,800. After that, half of all drug costs are paid out-of-pocket until the total amount reaches the catastrophic threshold, about $4,300. Then, Medicare covers 95 per cent.
The pros: The plan ensures that individuals who require costly medications can have access to them without having to spend exorbitant amounts.
The cons: The setup of the plan means that many people who require drugs but don't reach the catastrophic threshold must pay out-of-pocket, which can be a significant burden, especially for low-income individuals. The gap is known as the "donut hole" and has been the subject of intense debate and criticism in recent years. Changes introduced in President Barack Obama's health-care legislation mean that in 2011, individuals in the donut hole now only pay 50 per cent of costs for brand-name drugs.Report Typo/Error