Canadians fall through cracks without pharmacare: report

The rising cost of drugs prevents some Canadians from getting the treatments they need, the Canadian Health Coalition says in renewing its call for a national pharmacare plan.

The group held public hearings across the country from October 2007 through last March, with more than 250 Canadians talking about the difficulties faced with the cost, effectiveness or availability of prescription drugs.

Brenda Young of Prince Edward Island told the hearings that she and her husband work hard to support themselves and their two teenage children, but they live paycheque to paycheque.

"When I go for surgery, everything is covered," said Young, who has neurofibromatosis, an inherited condition involving fibre-like growths of the nerves and skin.

"But as soon as I am out of the hospital, there is no money for ongoing drugs or physical therapy.… If the children need prescriptions, I sometimes have to tell them to wait until payday."

Many Canadians don't have drug plans, and those who do face increasing costs, according to the report Life Before Pharmacare, released Tuesday by the Canadian Centre for Policy Alternatives.   

Drug coverage lost

"In this serious economic downturn, Canadians are losing their drug plans as they lose their jobs," said Kathleen Connors, chair of the Canadian Health Coalition.

"A public pharmacare plan will not only provide medically necessary drugs to all Canadians, regardless of where they live or work. It will also create more efficient spending in the health-care system. We'll get more and pay less."

The report recommends:

• A universal public drug plan to replace the expensive patchwork of private and public plans, with costs shared among federal and provincial governments and employers, and administered by the provinces and territories.
• A national formulary to cover the full cost of essential drugs, with decisions on what drugs are paid for based on independent evaluation of safety, effectiveness and value, with allowances made for special needs and circumstances.
• A national strategy to reduce drug prices by buying in bulk.
• A national public drug information system to provide unbiased drug information.
• Stronger, strictly enforced legislation to ban all advertising of prescription drugs to consumers in Canada.
• Improved prescribing behaviour so drugs are used only when needed, with the right drug for the right problem.
• Faster access to more affordable non-patented drugs and repeal of regulations that extend monopoly patents beyond 20 years.

The report stated that according to Health Canada, only 15 per cent of newly approved drugs are an improvement over existing drugs. The others are just a different version of what already exists but at a higher price and with monopoly protection for 20 years.

Efficiency is one of the strongest arguments for a universal pharmacare program, said Philip Lillies, who lives in Moncton, N.B., with his wife, who has multiple sclerosis.

Costs add up

"The hodge-podge of programs that attempt to substitute for it is not only unfair, they are also costly both in a financial sense and a social sense," said Lillies, who told the hearings that his wife was first affected with MS when she was in her 30s.

Now in her early 50s, she is unable to walk and doesn't qualify for benefits under the Canada Pension Plan, while New Brunswick offers no disability pension, Lillies said.

Other Canadians shared stories of struggles with government red tape, the cost of losing coverage when moving to another province, and young adults who are shut out of drug coverage.

Focus on high-cost drugs

Another group, the Best Medicines Coalition, which includes national disease and patient groups, has become disillusioned with the concept of pharmacare, said member Kathy Kovacs Burns.

Making the changes at the provincial level would involve opening up the Canada Health Act, which is "the only thing that's preserving drug coverage totally when you're in a hospital," said Kovacs Burns, also associate director for the Health Sciences Council at the University of Alberta in Edmonton.

"What might be more appropriate is looking at the high-cost drugs."

New Zealand's example

Michael McBane, national co-ordinator of the Canadian Health Coalition, countered that all provinces and territories are seeking a national co-ordinated approach to pharmaceuticals, and employers have also said they would prefer a public plan given administration and skyrocketing drug costs.

New Zealand bargains collectively to lower the cost of drugs covered by the formulary, McBane noted.

Dr. Jim Wright, a clinical pharmacologist at the University of British Columbia, said New Zealand has taken "a very proactive stance" and has been successful in keeping costs down. He said the country has shown it can be done without having any impact on people's health.

Organizations including the Canadian Auto Workers, the Canadian Federation of Nurses Unions and the Public Service Alliance of Canada helped to pay for the CHC hearings and the report.

Last week, a report released by the Competition Bureau suggested that making strategies changes to Canada's generic drug market could deliver up to $800 million in savings that could be returned to the consumer or reinvested in the health-care system.