Written by Hart Jansson
Chapter Lead, Halton Chapter – Council of Canadians
Halton Region, Ontario
March 2, 2018
No-fee Universal Pharmacare to the rescue?
According to a well-researched study published on Feb. 13 in the Canadian Medical Association Journal, 2 million Canadians could not afford at least one drug prescribed to them in 2015. This means that here in Halton, with a poverty rate just slightly above the provincial average, there would be 32,000 people who couldn’t afford at least one prescription drug in 2015. Statistically, according to the study, this would have led to 5,600 additional doctor visits, emergency room visits or hospital stays in Halton – these almost certainly cost our medical system many times more than the cost of filling these prescriptions.
According to the study, a further 1.2 million people cut back on groceries, heating or other expenses to afford their meds. Again, this means in Halton that another 18,000 people were having to cut back to afford their prescriptions. So, how do we decrease the suffering of these people and save the health system some money? No-fee Universal Pharmacare is a solution.
Most Canadians support our Universal Health Care system for good reasons – it covers almost every health problem. Unfortunately, Canada is the only developed country with Universal Health Care that does not also have Universal Pharmacare coverage. We have seen significant movement politically in the past few weeks, notably by the federal NDP and the federal Liberals, not to mention the recent under-25 Pharmacare coverage in Ontario, which signals a move toward some type of Pharmacare. Let’s look at some more basic facts before we consider what Universal Pharmacare means and might look like.
While knowing about a health problem is useful, it’s frustrating that the prescription drugs to treat them can be unaffordable for many Canadians. In 2016, Canadians spent $30B to fill more than 600 million prescriptions. The cost of maintenance drugs, like those used to control high blood pressure, has gone up 58 per cent since 2005. Meanwhile, specialty drugs including those used to treat cancer have skyrocketed 325 per cent. In Canada where we buy our prescription drugs individually, a year’s supply of the cholesterol-busting drug lipitor costs more than $800 in Canada. In New Zealand, where they have Universal Pharmacare and a public authority negotiates drug prices on behalf of the entire country, a year’s supply of lipitor costs just $15. Recent studies have estimated the potential savings to be realized with a Universal Pharmacare plan in Canada to be between $4B and $11B.
While many Canadians have some form of prescription drug coverage, most of us pay a portion of the cost, and some of us pay the entire cost. While seniors over age 65 and youth under age 25 in Ontario now have reasonable Pharmacare coverage, about one million other Ontarians have no prescription drug coverage at all.
The Council of Canadians and many other organizations including the Canadian Federation of Nurses Unions, the Canadian Labour Congress and Canadian Doctors for Medicare, prescribe No-Fee Universal Pharmacare as a remedy for the too-high cost of prescription drugs and as a remedy that ensures equity among all citizens. These organizations sent an open letter to Prime Minister Trudeau on Feb 28, expressing a number of concerns including Finance Minister Bill Morneau’s apparent conflict of interest in the matter.
The Oakville Chamber of Commerce, in partnership with the Ontario Chamber of Commerce, released a policy report on March 1st called ‘Principles for an Effective Pharmacare Program’, which suggests guidelines for the federal and Ontario governments to follow when considering reforms to pharmaceutical coverage.
The five key principles stated in the Chamber report are:
- Existing gaps in pharmaceutical coverage are identified and addressed to improve access to medications for those who need it
- The strengths of the public-private system are leveraged
- The program is outcomes-oriented and promotes the sustainability and efficacy of the broader health care system
- Patients can access their medications in a timely manner
- Broad and appropriate access to innovative medications is ensured
It is hard to argue with any of these principles, except perhaps the second one. This is where most of the controversy and discussion is likely to take place, both with respect to health-care content, and the political and commercial implications of different solutions.
On the one hand, one could argue that the current private system for prescription drug coverage, with higher than necessary prescription drug prices and a central role for private insurance companies, could be expanded. This type of system exists in Quebec and other countries such as France, with no reduction in drug prices and substantial fees often payable, even by low income recipients.
On the other hand, one could argue that the public system could be strengthened by using the free market principles of the private sector to achieve lower drug prices through single buyer negotiations. Costs could be lowered by minimizing the role of private insurance companies and having a single buyer (or few buyers) of prescription drugs which would enable much lower drug prices (such as those in New Zealand which negotiates drug prices as a single buyer). With universal, no-fee Pharmacare, private companies would save billions of dollars as there would be no further costs for prescription drugs for their employees or the associated insurance premiums. Employees would save any copayment associated with these prescription drug benefits. There would be a cost to the taxpayer, but overall a net savings of billions of dollars, according to informed experts. Lots of room for discussion there!
Consider calling your MP and/or MPP to tell them that you want a fair, no-fee Universal Pharmacare, with lower drug prices for Canadians.