Eric Hoskins is a physician and public health specialist. As a former provincial minister of health, he introduced OHIP+ providing pharmacare to all Ontarians under the age of 25.
Four years ago, as chair of the Federal Advisory Council on the Implementation of National Pharmacare, I published A Prescription for Canada: Achieving Pharmacare for All. The report was a detailed road map to achieving universal, single-payer, public pharmacare – something every other country in the world with universal health care has achieved, except for our own.
Too many Canadians die prematurely because they cannot access the prescription medicines they need, while the health of countless others worsens, leading to a poorer quality of life. Canadians who cannot afford medicines visit emergency rooms more often and are hospitalized more frequently – costing our health system billions of dollars every year.
One-fifth of Canadian households have a family member who, in the previous year, has not taken a medication because of its cost. An estimated one million Canadians borrow to pay for prescription drugs, while many more are forced to choose between medicine, heating their home or putting food on the table. In today’s economic climate, these indicators are only getting worse, with devastating effects, especially for the working poor.
Most Canadians believe that, like our public health care system, access to medicine should be based on need, not on the ability to pay. Instead, our current patchwork system of more than 100 public plans and thousands of private plans leaves millions of people with little or no prescription drug coverage.
Our 2019 report concluded that the most effective model – and the one that results in the greatest savings to both the health care system and taxpayers – is a public system where the added costs of pharmacare are paid for by the federal government. As a single-payer, the government has the purchasing power to negotiate the lowest drug prices.
Since the report was published, the federal government has made significant progress. Work is under way on a Canada Drug Agency that would operate pharmacare. Ottawa has also been working on a drug formulary – a list of medicines to be covered. And earlier this year, the government launched its national strategy on drugs for rare diseases, allocating $500-million a year toward the program. All three initiatives were priority recommendations by the council and are critical building blocks.
In addition, the Liberal-NDP supply-and-confidence agreement expiring in June, 2025, commits both parties to passing a Canada Pharmacare Act by the end of 2023. This agreement all but guarantees federal legislation creating pharmacare.
So why has this not happened yet? Cost is a major factor. But that is why our report recommends starting with coverage for essential medicines, projected at $3.5-billion annually, and then gradually reaching full pharmacare five to seven years later, at a cost of $15-billion annually. While this number may seem ambitious, it is important to look at this figure in the context of projected savings. Bulk purchasing of medicines would shave $5-billion annually from what Canadians currently pay for prescriptions. Public drug plans are also much cheaper to administer than private plans. Families will save, on average, $350 a year on medicines, while businesses will save $750 per employee. And our health care system will achieve significant savings, as pharmacare means more Canadians accessing the drugs they need to stay out of hospital, reducing the burden on our already taxed system. Just last week, a report from Canada’s Parliamentary Budget Officer bolstered this argument, stating that pharmacare would create economy-wide savings.
Reticence on the part of private insurers has also been a consideration. During the council’s consultations, private insurers who deliver employee drug plans recommended patching the holes in the existing two-tier system. Yet the council looked at the existing model and found it was at the breaking point, with many employers unable to absorb increasing drug costs, private insurers shifting high-cost medicines onto provincial public drug plans, and an ever-growing proportion of workers underinsured and unable to afford their medicine. We concluded that there will always be a place for private insurance, but that role will evolve, focusing more on covering co-payments and deductibles, generic-to-brand substitution, and access to other uncovered services.
The pharmaceutical sector has also expressed concern about the effect of pharmacare on bringing new drugs to market and other innovations. Currently, that process is slow and arduous, requiring lengthy negotiations with 13 provinces and territories, as well as with the federal government. Pharmacare will streamline the approval process, replacing 14 decision-makers with one. If a drug is safe, with proven value and positive health outcomes, it will be available and provided to Canadians more quickly through pharmacare.
It is time to move past these hesitations, as the overall benefits of pharmacare on the well-being of all Canadians are clear, irrefutable, and increasingly urgent. The “unfinished business” of medicare is finally within reach for Canadians – let’s make it a reality.