Pharmacare Facts

Diana Clarke, February 1, 2018

Canada is the only developed country with an universal health care that does not have universal Pharmacare coverage.

 In 2016, Canadians filled more than 600 million prescriptions at a cost of $30 billion. Across Canada, Canadians have varied drug coverage and will pay different out of pocket drug expenses for the same medication. Those employees covered by a workplace drug plan will be subject to premium payments, co-payments and deductibles. One third of working Canadians do not have any employer partly or fully paid prescription drug coverage. Vulnerable and lower income workers are particularly affected. Generally, the less you earn will likely to have less or no coverage.

 What is Universal Pharmacare?

  • Universal prescription drug coverage (including some supplies for some chronic medical conditions) for all Canadians covered by a provincial or federal medicare plan (i.e. for Ontario – OHIP)
  • Prescription drugs must have a Drug Identification Number and approved by Health Canada
  • Ontarians access drugs by presenting their OHIP card to the pharmacist and the pharmacist will charge the OHIP system directly. Normally the user may be expected to pay type of co-pay. The current Ontario Drug Benefit is up to $6.11 or up to $2 for people living on lower income. Some pharmacists will waive the $2 fee. Sometimes, a single person or family may have to pay one-time fee $100 each year depending on income.
  • OHIP covers up to Age 25, 65 and over and those receiving social assistance.
  • Not all approximately 6,000 drugs are covered as there is an Ontario Drug Benefit Formula which currently covers 4,400 drugs
  • Some expensive drugs may be subject to special authorization applications
  • Generic substitution where possible

What are the Savings?

  • Anyone with an employer plan must claim first with OHIP and if not covered, then claim on their employer extended health plan – costs for employers’ plans would come down drastically. Implementation would make our businesses more competitive and less costly (Annual $8 billion savings nationally)
  • Would help particularly women with precarious and/or lower income work
  • The recent Sears employees and retirees under age 65 were affected as they lost any drug coverage once unemployed
  • We can save $14 billion a year nationally by:
    • Bulk purchasing of drugs – reduces wholesale costs
    • Limits unreasonable markup (profit)
    • Fixed pharmacist dispensing costs
    • Reduced Administration
  • Canadians will have better treatment and successful medical outcomes

What are the Numbers for Coverage?

  • 3.5 million Canadians don’t have even basic prescription drug coverage.
  • There are approximately 2.2 million more people will be covered in Ontario alone
  • One third of paid employees in Ontario do not have employer-provided medical or dental benefits
  • One quarter of Ontarians between age 12 and 64 do have prescription medical insurance
  • Ontarians paid $2.5 billion out of pocket for prescription drugs representing 22% of total drug costs in Ontario
  • 25% of Ontarians and their households did not take their prescriptions or did not renew to save costs

What do We Want?

For All Canadians:

  • Implement a National Pharmacare Program for all Canadians
  • Amend the Canada Health Act to allow for a National Drug Formulary for medically necessary drugs, including a drug monitoring agency providing regulation and oversight
  • Facilitate the provincial implementation of the national Pharmacare system

For Ontarians:

  • All Ontarians covered by an universal Pharmacare program across the country
  • Administered by the Government of Ontario, using OHIP card system
  • No deductible but could consider a reasonable co-pay which could be waived for low income individuals
  • Cost savings through bulk buying and setting of reasonable markup and dispensing fees

What can we do?

  • Educate Canadians about the need for Universal Pharmacare
  • Lobby with our MPPs and MPs
  • Sign the petitions
  • Discuss this issue with our fellow Canadians

 

 

 

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