Long-standing calls for a national drug plan in Canada have grown louder with two new reports that argue such a plan could save governments billions and improve access to medicines for all groups of people, including the elderly.
Without that national approach, provinces and territories are hamstrung when it comes to negotiating better deals, says the lead author of one of the new reports.
"The problem is not that seniors are getting drug coverage through the public purse – the problem is that we don't have universal drug coverage through the public purse," Steve Morgan, director of the Centre for Health Services and Policy Research at the University of British Columbia, said on Wednesday.
"And in Canada, by way of having a system that does not provide universal public coverage for prescription drugs, we basically remove our capacity to be effective managers of drug costs."
Under the current system, buying power is divided not only among provinces and territories but among insurance companies that provide drug plans to companies or individuals, he added.
In a paper released Wednesday by the Institute for Research on Public Policy, Prof. Morgan and two co-authors pitch a national drug program through a comparison of drug coverage plans in B.C. and Ontario. In 2003, B.C. shifted from an "age-based" system that provided drug coverage for people 65 and over to an "income-based" program that provides benefits based on household income. Saskatchewan, Manitoba and Newfoundland and Labrador have also moved to income-based programs.
While the changes in B.C. reduced the public share of drug expenditures – by $134-million in 2004 alone – they did so by shifting costs to the private sector, Prof. Morgan says in his report. As well, the new program meant some seniors skimped on drugs they were instructed to take.
Instead of income-based systems, the authors recommend a Canada-wide, no-deductible prescription drug benefit program financed through personal income taxes.
Also on Wednesday, Canadian Doctors for Medicare released a report, Affordable Access to Medicines: a Prescription for Canada, that said bringing the cost of drugs down to the Organization for Economic Co-operation and Development average would save Canadians an estimated $9.6-billion a year. Negotiating the best international price for 82 of the most commonly prescribed generic medicines would save $129-million for the government of Ontario alone, the same report said.
In an opinion piece in The Globe and Mail in October, Ontario Health Minister Eric Hoskins backed calls for national pharmacare, noting that Canada is the only industrialized country with universal health insurance that does not also have a national drug coverage policy.
Health care is a provincial responsibility, but the federal government oversees drug safety, advertising and patent regulations. That "jurisdictional overlap" means it is more important for provincial and federal governments to co-operate on drug policy than on nearly any other aspect of health care, Prof. Morgan said.
Some co-operation has already taken place. Over the past few years, provincial governments have teamed up to buy some generic drugs in bulk to save money.
Last year, $29.3-billion was spent on prescription drugs in Canada, according to the Canadian Institute for Health Information. Governments spent $12.2-billion, or 41.6 per cent of the total. The public share of prescribed drug spending ranged from a low of 29.3 per cent in New Brunswick to a high of 47.6 per cent in Saskatchewan.