A federal government-appointed panel’s initial report on pharmacare does not address any of the vexing questions about how universal prescription-drug coverage would work or who would pay for it, according to groups representing doctors, patients and the private-insurance and pharmaceutical industries.
But there could be merit in the panel’s proposals for a national drug agency and a master list of drugs covered for all, depending on how those ideas are carried out, the organizations said.
“Our key takeaway is that [the report] doesn’t describe the how,” said Gigi Osler, president of the Canadian Medical Association, which represents physicians across the country. “How will national pharmacare be delivered?”
Finance Minister Bill Morneau and Health Minister Ginette Petitpas Taylor on Wednesday unveiled an eight-page interim report from the Advisory Council on the Implementation of National Pharmacare, a panel the Liberal government established in last year’s budget.
The seven-member council, led by former Ontario health minister Eric Hoskins, urged the government to adopt a program whose core principles would include universal coverage of prescriptions based on medical need, consistent drug coverage across provincial lines and a “robust pharmaceutical management system” that would help to keep drug costs in check.
However, the council decided to reserve its advice on how to get there – whether through a public, single-payer system or the beefing-up of the existing private-public model – until its final report, due this spring.
Ms. Petitpas Taylor, a former social worker whose clients sometimes struggled to afford their medications, told a news conference in Toronto that “Canadians should not have to choose between paying for prescriptions and putting food on their table. We must complete the dream of Medicare by finally finding its missing piece and that missing piece is pharmacare.”
Mr. Morneau would not say whether his government intends to include any funding for national pharmacare in its March 19 budget, the last before Canadians are scheduled to go to the polls in October.
Both ministers said the release of the interim report had been in the works for weeks, and was not timed to distract from the appearance of Gerald Butts, Prime Minister Justin Trudeau’s former principal secretary, before the Commons justice committee probing the SNC-Lavalin controversy.
British Columbia’s Health Minister, Adrian Dix, said that if the federal Liberals want buy-in from provincial governments they will need to pay more of the country’s prescription-drug bill, now shouldered mostly by provinces and workplace insurance plans.
“Ultimately," Mr. Dix said, “if the federal government is determined to do this, they will have to demonstrate this with the investment of money.”
Steve Morgan, a health economist and pharmaceutical-policy expert at the University of British Columbia, predicted the federal budget would include some money to establish a national drug agency – a relatively inexpensive undertaking compared with paying the federal share of a single-payer, government-funded pharmacare system. (Mr. Morgan conducted some research for the council, but had no involvement in its recommendations.)
The interim report called for a new, arm’s-length drug agency to oversee the health-technology assessments (HTA) that evaluate the efficacy and cost-effectiveness of new medicines; spearhead negotiations with pharmaceutical companies; and manage a “comprehensive, evidence-based national formulary,” which is a list of drugs covered for everyone.
Canada already has two HTA organizations – one for Quebec, the other for the rest of Canada – and a separate office that negotiates discount deals with drug companies on behalf of the provinces, territories and Ottawa.
But a national formulary would be new for Canada. “This [idea] is either ridiculously simple, or very complex and politically challenging,” Mr. Morgan said. “I think it’s probably more the latter.”
Right now, Canada has more than 100 public and 100,000 private insurance plans, many of which cover a slightly different list of prescription drugs.
A 2017 analysis of 729 drugs by the federal drug-pricing regulator found that when each pair of public formularies was compared, they covered the same drugs 82 per cent of the time. The lists were much more likely to match up on routinely used generic drugs than on brand-name drugs, especially when those drugs cost $10,000 a year or more, the study found.
Drawing up a definitive list could be difficult, especially considering private-insurance plans tend to be more generous than existing public ones.
“When you look at the types of coverage that you get from public plans in Canada today, they are universally narrower than what people would get on a private plan,” said Stephen Frank, president of the Canadian Life and Health Insurance Association, which represents private insurers. “You’ve got to think [it] through carefully: Are you going to be making people better off at the end of this reform or not?”
With a report from Justine Hunter