Well, it’s a start.
The Interim Report of the Advisory Council on the Implementation of National Pharmacare can generously be described as modest.
The council, led by former Ontario Health Minister Eric Hoskins, made only three recommendations:
1. Create a national drug agency;
2. Develop a comprehensive, evidence-based national formulary;
3. Invest in drug data and information technology systems.
As self-evident as it may be to say there can be no national pharmacare until these building blocks are in place, there is an important message that jumps out from between the lines: If the federal, provincial and territorial governments can’t agree on these basics, there is not really any point in carrying on with this discussion.
These are sensible, well-worn proposals but they have not exactly been embraced enthusiastically. In fact, the silence of the provinces has been deafening.
A single national formulary should be a no-brainer. If all jurisdictions had a common list of drugs that are covered by public insurance, it would make bulk buying easy, and spare clinicians and patients alike a lot of guesswork.
Yet, if provinces and territories can’t agree on something as basic as which vaccines children should get and when, can they really be expected to agree on which of the 13,000 prescription drugs on the market will be on a common formulary?
Similarly, every jurisdiction has drug data and information systems (plural) but they don’t all talk to each other. And, even if there was interoperability, the data may not be shareable because privacy legislation is slightly different in every province.
Creating an arms-length national drug agency should be easy – in theory. The Canadian Agency for Drugs and Technologies in Health (CADTH) already exists, and its mandate could be expanded with the stroke of a federal pen. But that kind of expansion - which was recommended in a report last year - would be rather pointless unless there is no buy-in up-front from the provinces, beginning with a real willingness to create a national formulary and cohesive IT system.
Don’t forget either that the three recommendations released Wednesday are just the preliminaries.
In its final report, slated for release before summer (when the federal election campaign will begin in earnest), Dr. Hoskins and his council-mates need to tackle the really tough issues like philosophy, structure and funding.
The loudest and most persistent voices have been those demanding a single-payer public pharmacare program – an expansion of the current medicare model for hospital and physician care to ensure first-dollar coverage of medically necessary prescription drugs.
The alternative is a fill-in-the-gaps approach, leaving the current mix of private and public drug plans in place, but targeting the under-insured and uninsured – about 1 in 5 Canadians - so no one is denied affordable access to essential drugs.
There also needs to be a solution proposed to the ever-more-challenging issue of how to pay for expensive new therapies for everything from cancer to rare diseases.
Then there is money.
Historically, the only way we get new health initiatives in Canada – including medicare itself – is when Ottawa dangles big bucks at the provinces.
There doesn’t appear to be a lot of appetite for that from the beleaguered Trudeau government, but we will get a better sense of that when the federal budget is tabled March 19.
Complicating matters is that, while we’ve been told repeatedly than a national pharmacare program would save billions of dollars, it would require a huge transfer of spending from the private sector to the public sector.
That means more taxes, in some form, an unappealing prospect, especially in a federal election year.
Remember, the role of the Advisory Council on the Implementation of National Pharmacare is not to tell us, once again, that pharmacare is a good idea. It is to tell Canadians *how* it can be done – and convince politicians and policy-makers to act, something they have failed to do for half a century.
Ginette Petitpas-Taylor, the federal health minister, stated the both the importance of pharmacare and the magnitude of the pharmcare challenge well at a press conference on Wednesday:
“Finding the ‘missing piece’ of medicare is nothing short of a nation-building project. And – to paraphrase John F. Kennedy – we choose to do it not because it is easy, but because it is hard.”
Dr. Hoskins has given us a glimpse of just how hard, and he’s only just begun.