In the 2004 federal-provincial Health Accord, Canadians were promised a National Pharmaceuticals Strategy, one whose cornerstone is a catastrophic drug plan.
With spending on prescription drugs at $20.6-billion and galloping upward at a rate of 12 per cent annually, the growing challenge posed by expensive new drugs for rare (and not-so-rare) diseases, and escalating concerns about drug safety and appropriate prescribing practices, getting a strategy in place is the most pressing issue in the health-care field.
However, two years after the accord, the NPS is still largely a good idea mired in a bureaucratic bog, and millions of Canadians are suffering unnecessarily -- financially, physically and emotionally -- as a result.
The underlying principle of medicare is that Canadians should have equitable, affordable, quality health care.
The universal health insurance scheme was put in place to ensure that no one suffer undue financial hardship in accessing medical care, specifically hospital and doctors' services.
Today, prescription drugs are an essential element of care. But Canadians depend on a confusing patchwork of public and private drug plans, and are subjected to myriad rules about what is covered where.
Access to prescription drugs depends largely on where you live and where you work, not on need.
At least 600,000 Canadians -- almost all of them in Atlantic Canada -- have no drug coverage at all. Another six million Canadians have inadequate drug coverage -- basic treatments for common conditions such as diabetes pose a serious financial hardship, and treatment of conditions such as colon cancer or rare illnesses such as Gaucher's disease is utterly unaffordable or inaccessible.
This yawning care gap is at odds with the principles of medicare and offends Canadian values.
The answer is to extend medicare guarantees beyond hospital and physician services to ensure universal timely access to safe and effective prescription drugs: in other words, pharmacare.
Politicians, largely for financial reasons, have shied away from this approach. Instead, they have embraced the notion of catastrophic drug coverage -- placing a cap on how much Canadians pay out-of-pocket for prescription drugs.
This is an eminently sensible and utterly necessary public policy.
So what's the holdup?
Sadly, politicians are still bickering about trivialities such as the threshold. Roy Romanow recommended that anyone spending more than $1,500 annually out-of-pocket be entitled to catastrophic drug coverage; Senator Michael Kirby suggested that relief kick in at $5,000.
Surely our political leaders can agree on a number in that range and get on with it.
The proposed national pharmaceutical strategy includes a number of other issues besides catastrophic drug coverage:
Establishing a national formulary. Work has begun in this area, particularly with the creation of a Common Drug Review for new drugs.
The problem is that provinces routinely reject the CDR's recommendations for base political reasons and, in doing so, perpetuate the inequities and continue to fund drugs that are not cost effective.
The CDR needs to be extended to all drugs -- and respected -- to reduce glaring inconsistencies;
Special attention needs to be paid to expensive drugs for rare diseases.
This is an explosive issue, but one that reminds us that mechanisms need to be developed to judge, rationally, what should be covered (and not covered) by public health plans;
Implementing drug pricing and purchasing strategies to obtain the best prices for drugs and vaccines. Patented prescription drug prices are regulated in Canada. But if Canada also regulated non-patented prescription drugs (mostly generic drugs), the drug bill could be reduced by $1.5-billion a year;
Strengthening the evaluation of real-world drug safety and effectiveness. A lot of drugs that look good in clinical trials don't work nearly as well in the real world. Mr. Romanow recommended the creation of a National Drug Agency to do monitoring and to provide information to consumers, but little has been done in this area;
Broadening the practice of e-prescribing by developing electronic health records. Tracking prescriptions electronically can sharply reduce waste and help avoid dangerous adverse reactions, but e-prescribing remains a rarity;
Improving the prescribing behaviour of health professionals. No one likes to talk about it, but there is a lot of inappropriate prescribing going on: expensive drugs used when cheaper ones work fine, along with over-prescribing and under-prescribing of treatment for various conditions. Physicians, nurses and pharmacists with prescribing powers need access to good, impartial data; now, they are too dependent on pharmaceutical company bumpf.
When a national pharmaceuticals strategy is in place -- in deed, not just on paper -- Canadians will be safer and healthier. They will also get more bang for their health-care buck and have a medicare system that is more fair and more just.
The starting point is the implementation of catastrophic drug coverage, without delay.
What we have now is not a strategy, it is a catastrophe of public policy.