Canada needs 'defined model' of universal pharmacare, citizen panel urges

Canada needs a comprehensive system of universal drug coverage to eliminate variations between the provinces and territories, a citizen-driven panel looking at the idea of national pharmacare recommends.

The Citizens' Reference Panel on Pharmacare in Canada — comprised of 35 volunteers randomly selected from across Canada, similar to a coroner's jury — met in Ottawa for five days and heard from 20 experts to produce a report on the issue.

The report, entitled "Necessary Medicines", was presented today to the House of Commons' Standing Committee on Health.

"In public opinion research that's been conducted, Canadians routinely support some form of pharmacare," panel chair Paul MacLeod said. "But that's always been a placeholder. We haven't really had a defined model that Canadians are saying they would endorse. That's part of what this report provides."

The panel's recommendations include:

• Creating a new national formulary of universally publicly covered medicines that accommodates the full range of individual patient needs, including rare diseases.
• Requiring all covered drugs to undergo a rigorous evaluation process to ensure both the efficacy and value-for‐money of funded treatments.
• Endorsing an ongoing role for private insurers in providing supplemental coverage.

'Have your cake and eat it too'

Canada is the only developed country with universal health coverage that does not also offer universal prescription drug benefits. 

An estimated one in 10 Canadians can't fill prescriptions because of the expense.

Colleen Flood, director of the Centre for Health Law, Policy and Ethics at the University of Ottawa, is one of the experts who presented to the panel. She supports the idea of a Canada-wide pharmacare plan.

"Essentially for pharmaceuticals needed outside the hospital, we pretty much have a U.S.-style system," Flood said.

Under a national plan, Flood said Canadians could have access to pharmaceuticals without breaking the bank, just as medicare does for hospital and physician services.

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"Other countries show us that you can have your cake and eat it too," she said. "You can have full public medicare, covering everybody, and you are going to spend less, not more."

While Canadians may appreciate that a national pharmacare plan would allow governments to negotiate lower drug prices, Flood said governments will also need to be able to say no if a drug doesn't pass the bar on efficacy or cost-efficiency.

For its part, the panel suggests starting with a short, basic list of essential medicines comprised of frequently prescribed drugs — one that could expand once a national formulary is in place. 

Cracks in current system

Emily Dukeshire of Calgary was one of the citizen panellists. Dukeshire said she became interested in pharmacare when she gave birth 18 months ago and had to go on medications that weren't covered. Dukeshire brought her baby daughter,  Zoey, with her to Ottawa.

"What really motivated me was that there's people who fall through cracks of our system right now. People who are not getting the drugs they need, and it costs the system money because people can stay in the hospital and get drugs for free," Dukeshire said.

Canadians now spend almost $30 billion a year on prescription medicines.

A national pharmacare program was originally recommended in 1964 as part of the Royal Commission on Health Services, also known as the Hall Commission, as well as in later reports, such as the 2002 Romanow Commission.

As for why national pharmacare hasn't yet been implemented, Flood pointed to two reasons:

• Most Canadians have private health insurance through employers. 
• A lot of provinces have legislation to cover the poor and elderly.

"It leaves a gap, but it also doesn't leave a lot of political momentum for people to do much about it, because most of us are OK and we think we're covered," Flood said.

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The citizens' panel suggested the government could fund the program through "modest" income- and corporate-tax increases, MacLeod said.

"Another major reason is none of us want to pay more taxes, but we do have to acknowledge that we are paying taxes now in the form of tax breaks for employers that cover health insurance," Flood said. 

The panel's research was funded by the Canadian Institutes of Health Research. A committee of clinicians, senior public servants and health researchers from across Canada oversaw the process.

Dukeshire said she was impressed with the process. Panelists were randomly selected from about 1,000 representative people who had volunteered to take part in the process to advise policy-makers on drug coverage for Canadians.

"This whole process was really amazing that we were all so different and from all across the country, and yet we went through this process together and we were able to come up with core values that we all believed. We were able to define some issues and then come up with some solutions together," Dukeshire said. 

Other speakers included doctors, nurses, pharmacists, brand name and generic manufacturers, insurers, retailers, patients, public agencies, academics and former policy-makers. 

A national drug plan is not officially on the federal government's agenda of priorities.