National pharmacare plan needed, experts tell Senate Open CaucusPublished on 9 June 2015 Publications by Senator Art Eggleton (retired)
‘Every developed country with a universal healthcare system provides universal coverage for prescription drugs, every developed county except for Canada,’ says Steven Morgan, a professor at the University of British Columbia and founder of Pharmacare 2020.
Canada should establish a national pharmacare program to ensure that all Canadians have access to the medications they need, though there is some worry about the cost of such a program. This was the view given by panelists who appeared before a public Open Caucus hosted by the Senate Liberals last Wednesday.
“Every developed country with a universal healthcare system provides universal coverage for prescription drugs, every developed county except for Canada,” stated Dr. Steven Morgan, a professor at the University of British Columbia and founder of Pharmacare 2020. “Our Medicare system in essence ends when a doctor hands a patient a prescription to fill, and they may or may not then have coverage for those prescriptions, depending largely on where they live, what their age is, and who they work for.”
Currently, Canadian drug programs differ from province to province, with varying systems on how medications are paid for; from catastrophic coverage based on income in British Columbia to compulsory coverage in Quebec, where individuals are required to have insurance either privately or through a provincially run public program.
Dr. Danielle Martin, vice-president of medical affairs and health system solutions at Women’s College Hospital in Toronto noted that under this current approach to drug coverage in Canada, one in 10 Canadians are unable to afford the prescription drugs they need. “Every doctor in Canada can tell you stories about the patients in their practice who cannot afford to fill their prescription and the effect of that on the health of those individuals,” Martin said. She also noted that untreated conditions lead to an increased use in emergency room visits, placing a strain on the health care system.
A recent study they published in Canadian Medical Association Journal stated universal drug coverage could reduce total spending on prescription drugs in Canada by $7.3-billion, most of which would come in the form of private savings to Canadians. However, the cost to the public purse would increase by an estimated $1-billion a year.
It was this additional cost to government that concerned Dr. Brett Belchetz, an emergency room doctor in Toronto and senior fellow at The Fraser Institute. Beltchetz noted that, while he supports the idea of a pharmacare program at some point, he worries cost overruns will rise well above estimates, and would divert precious dollars away from an already strained healthcare system. “By introducing something like pharmacare, which may bring significant extra costs to our system, we may actually worsen the real source of our poor performance, which is wait times,” Beltchetz noted.
The suggestion that pharmacare would not be panacea in correcting the ills facing Canada’s healthcare system however does not mean it is not worthy of pursuit. In answering a question regarding the overall poor health of Canada’s aboriginal population, who receive federal drug assistance, Martin noted that access to appropriate medication is just one piece of a larger puzzle when working to improve a population’s health. “So much of what determines the health of a population is not determined by access to healthcare of any form. … In fact 80 per cent of the health of populations is determined by what we would call the social determinants of health; income, education, housing, social cohesion, dignity,” she stated. We should certainly pursue a pharmacare program, but it is not the “beginning, middle and end of the [healthcare] conversation.”
If Canada does decide to pursue a publicly-funded pharmacare program it is clear that many stakeholders must be consulted before a decision is made. Owen Adams of the Canadian Medical Association stated that employers rely on the benefits they offer to recruit and maintain qualified employees, while many retirees already enjoy excellent drug coverage programs as a part of their retirement package. Ultimately for Adams, such consultations require leadership from Ottawa if they are to be successful. “I do not think it is feasible to have a national standard of access to prescription drugs without the participation of the federal government,” he said.
Martin also encouraged federal leadership in this area. “In my view the role of the federal government must be as a convener, as a funder, and as a setter of standards to help us navigate our way through very tricky policy areas which will not get less tricky if we avoid the conversation about universal pharmacare,” she stated. “The bottom line for me is that if the promise of medicare is the provision of access to healthcare services based on need, rather than ability to pay, we are quite simply failing when it comes to prescription drugs, and there is no justifiable reason, economic or otherwise, to continue as we are.”
Liberal Ontario Senator Art Eggleton co-chairs the Senate Liberal Open Caucus meetings.