Nova Scotia's seniors' pharmacare needs overhaul, not tinkering

Nova Scotia needs to overhaul its seniors' pharmacare program, not just tinker with it, say two researchers who have studied drug costs and pharmaceutical programs extensively.

In April, the provincial government wants to start charging annual pharmacare premiums based on income and raise the premium maximum to $1,200. 

The change has caused furor among some seniors who will have to pay significantly more than the current cap of $424, even as the province notes most of 120,000 enrolled in the program will pay the same or less.

The governing Liberals claim it will make the system more fair and ensure the plan's long-term health.

But that's not the way University of British Columbia's Steve Morgan sees it. He teaches health policy and has written widely on pharmaceutical coverage.

"Tinkering with the status quo, changing premiums or eligibility criteria for our existing public programs is just basically denying that we have a fundamentally flawed system," he said in an interview.

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Dalhousie University political scientist Katherine Fierbeck said the current system of fragmented provincial programs doesn't give individual provinces much clout when negotiating price with powerful multinational pharmaceutical corporations. 

The other drawback is it leaves less populous provinces such as Nova Scotia to compete with population powerhouses Ontario and Quebec.

"The unspoken question is whether drug companies are willing to cut deals with their best customers if they know that they can recoup the costs with other jurisdictions who are not as able to drive as hard a bargain," said Fierbeck, who studies health-care politics and provincial drug plans.

Canada needs national program

Both researchers feel a single national program with the means to test and evaluate drug effectiveness would serve Canadians best.

Fierbeck said Italy, for example, negotiates deals that offer rebates if a drug doesn't live up to a pharmaceutical company's claims.

"I think that Italy has actually collected about 200-million Euros in refunds from these deals," she said.

Morgan agrees the key is to find a way for provinces to get what they pay for when they stock their drug-plan shelves.

"Ensuring that the ways that people are using medicines and the price we are paying for them are appropriate," he said. "They (should) reflect the best evidence and reflect value for money."

That's especially important for Nova Scotia, said Fierbeck, given the province's demographics. The province has the highest percentage of seniors in Canada.

She said many of the new, more expensive drugs are being developed for cancer treatment and arthritis.

"Of course, because we have an older population we have a much higher rate of cancer," she said. "Another class of drugs targets arthritis and again we have a very high prevalence of arthritis in this province as well."