Nav Persaud is a family physician and the Canada Research Chair in Health Justice at the University of Toronto.
Steve Morgan is a professor at the school of population and public health at the University of British Columbia.
After coining the term “caremongering” during the COVID-19 pandemic, Canadians have shown each other, and the world, that it’s possible to work together to collectively ensure that everyone’s needs are adequately met. Communities are rallying to support neighbours and strangers alike. Celebrities are raising millions of dollars for charities.
But some problems are too big for community mobilization, which is why robust public policies are still needed to support all Canadians during and after this crisis.
One such policy would be the creation of a national pharmacare program. Since the 1960s, five separate national commissions have recommended that medically necessary prescription drugs be included in Canada’s universal public-health insurance system. Just last year, Prime Minister Justin Trudeau’s Advisory Council on the Implementation of National Pharmacare produced an evidence-based and practical implementation plan that would begin this year.
Some might question whether Canada can afford national pharmacare in the wake of the COVID-19 pandemic as governments face massive deficits, but the case for such a program has never been stronger. Canada’s current patchwork of private and public drug plans wastes billions of dollars each year.
For every citizen, we spend at least 50 per cent more on pharmaceuticals than countries with universal single-payer pharmacare systems (for example, Britain). These other countries do not save money by using fewer medicines than we do – their collective purchasing power yields lower drug prices for brand-name and generic drugs. Canada could do this, too, while improving access to medicines at the same time.
More than three million Canadians lost their jobs in March and April, as large swaths of the economy shut down. Millions more may lose their employment over the course of the coming year. Despite measures to provide temporary income assistance, such as the Canada Emergency Response Benefit, all Canadians who lose their jobs will have less income to pay for medicines. Those who were fortunate enough to have had work-related health insurance will lose that, too.
Even before COVID-19, the parliamentary standing committee on health estimated that Canada’s patchwork of private and public drug plans left one in five Canadians with little or no prescription drug coverage. This situation had already led to dire consequences – in 2016, higher drug costs made Canadians three times more likely to skip prescriptions than residents of comparable countries (such as Australia and New Zealand) who had integrated universal drug coverage into their universal health care systems.
Thousands of Canadians already end up in hospitals every year as a result of their inability to afford the medicines they need. More will do so as a result of their reduced income and loss of work-related private health insurance – right at a time when we need Canadians to avoid hospitals as much as possible. Worse yet, hundreds of Canadians die each year because they cannot afford prescriptions to manage otherwise manageable diseases such as diabetes, and poor disease control can worsen COVID-19 outcomes.
As recommended by the national pharmacare advisory council, the federal government could direct an immediate $3.5-billion to provinces to provide universal public coverage of an essential medicines list for a one-year period. This would be universal public coverage of the approximately 100 medicines of greatest importance to the health of the Canadian population – medicines that already account for more than half of all prescriptions Canadians use.
Evidence indicates that covering such essential medicines would improve the quality of health care for Canadians and help many families make ends meet. It would keep Canadians healthy in a time of crisis and could be scaled up. Government estimates indicate that, over time, doing so would also save Canadian businesses and households approximately $5-billion more a year than it will cost our government.
National pharmacare is an overdue policy that was already in the works before COVID-19 made the need for it more acute. Canada’s pandemic response has shown that all levels of government can work together when needed. Implementing universal, national pharmacare could be a permanent expression of the co-operation seen during this crisis, and the new policy would do even more good than caremongering.
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