Canada is the only developed country in the world with a universal health care system that doesn’t include universal coverage of prescription drugs.
The federal Liberal Party promised to “take the critical next steps to implement national universal pharmacare” during the 2019 election, and some subsequent throne speeches, but the discussion appears to have been largely sidelined since the pandemic.
That’s even though Canadians continue to support universal prescription drug coverage. An Angus Reid Institute survey released last fall showed 86 per cent of Canadians support pharmacare, and 77 per cent said increasing coverage for Canadians should be a high priority for government.
While Prime Minister Justin Trudeau’s minority government appears to have the political support necessary to push through a pharmacare plan, given that the NDP is fully behind it, not all provinces are. Cost is also a concern, especially as the government’s COVID-19 expenses continue to pile up.
The resurgence of pharmacare
Universal, public coverage of prescription drugs has been discussed in Canada for decades. In the 1960s, the Hall Commission recommended national pharmacare, to no avail. The issue resurfaced most recently in the summer of 2019 when an advisory council appointed by the Liberal government recommended the creation of a new drug agency that would draft a national list of prescription medicines that would be covered by the taxpayer, beginning with an initial list of common and essential drugs, by Jan. 1, 2022.
The panel, led by former Ontario health minister Eric Hoskins, said the cost would be $3.5 billion in 2022 and rise to $15.3-billion by 2027, as the list of covered medications expands. The panel also forecasted Canada would spend $5-billion less each year on prescription drugs by 2027, “while at the same time improving access and providing universal public coverage for all Canadians.”
Creating a pan-Canadian pharmacare sounds simple, in theory, but experts say it’s more complicated in practice since Ottawa would have to get the back of each province and territory, given Canada’s decentralized health care system and overcome well-connected drug industry lobby groups.
“Having studied this file for basically 25 years, that’s the biggest challenge. It takes political leadership and courage to put the system in place that prioritizes the ordinary Canadian over those power interests.”
Still, the math is compelling. Canadians spent a whopping $34-billion on prescription medicines in 2018 and pay more for drugs on a per capita basis than comparator countries except for the U.S. and Switzerland, according to the federal government. It also says 20 per cent of Canadians struggle to pay for their prescription medications, and an estimated three million people don’t fill their prescriptions because of affordability.
Why universal drug coverage makes sense
Paying for health care but not drugs also doesn’t make much sense, argues Steve Morgan, a professor of health services and policy with the University of British Columbia in Vancouver.
“If you are going to bother to pay for the medical treatments that diagnose and prescribe treatments, you should probably pay for the treatments themselves to keep people out of the hospitals that you will also be paying for,” he says, adding that there’s already a rudimentary system at the provincial level across much of the country for the retired and people on social assistance. “It’s not like it’s hard in a technical or even operational sense; it’s hard politics.”
Getting Ottawa and the provinces and territories to agree on anything substantive is rare. The last major success was with the launch of medicare in the 1960s. There’s also the issue of dealing with pharmaceutical companies, which would likely see lower profits as a result of a national buying program.
“In every other country that is comparable to Canada, they use the power of the program to secure better prices for medicines,” Mr. Morgan says.
Even Australia, which has one of the more expensive universal pharmacare programs among western countries, wrings out $7-billion in drug cost savings compared to Canada, says Mr. Morgan.
“The politics of that are not that Canadians don’t want to have $7-billion in savings, it is that the manufacturers of the medicines that are being priced at levels higher in Canada than those other countries don’t want to see those savings. Because to them, those are lost revenues.”
Opposition to the implementation of single-payer pharmacare generally comes from the right-wing of the political spectrum and arguments that it would be very costly and unnecessary.
Instead, it’s argued that government should focus on gaps in coverage for Canadians who need assistance in buying prescription drugs rather than creating a new national benefit. “This is going to cost a lot of money,” says Bacchus Barua, director of health policy studies with the Fraser Institute in Vancouver.
For instance, the Angus Reid Institute study found that 23 per cent of Canadians may need some sort of financial assistance for prescription drugs, but Mr. Barua believes the answer is not a national program.
“Unfortunately, the proposals we are seeing right now are for a broad pharmacare program for the general population, many of whom can actually well afford their own costs, have primary insurance and may be millionaires for all I know,” he says.
As now it stands, the provinces and territories are not agreed on universal pharmacare, but seem united in asking for more health care dollars from Ottawa, last month requesting the federal government up its share of costs from 22 per cent to 35 per cent.
It appears that Ottawa will take a slow cautious approach. Last month it pledged to give P.E.I. $35-million over four years to allow the island province to add new news to its list of coverage pharmaceuticals.
The federal government heralded the agreement with the country’s smallest province as a step towards national pharmacare. “That’s effectively more of the same. It is not what physicians and patients would really want in my opinion,” says Nigel Rawson an epidemiologist and pharmaceutical policy researcher in Saskatoon.
“If it’s just to provide essential medicines, which is a small group of drugs for common illnesses, we don’t need national pharmacare for that we need assistance to improve what we have got,” he says. “If it’s to ensure that Canadians are going to benefit from sort of new innovative, ground-breaking medicines that are coming out and are affordable and accessible opportunities, that’s fine.”
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