Surveys and polls regularly show how proud Canadians are of our universal health care system, particularly in light of what's going on nowadays in the U.S. Indeed, unlike many of our southern neighbours, Canadians don't have to worry about filing for bankruptcy to get proper care for themselves and their families.
But when it comes to prescription medications, our health care system comes up short.
That's because most medications outside of the hospital setting are not covered by our universal health care system, meaning Canadians must rely on private drug insurance, or else, pay for costly medications out-of-pocket. Some provinces do offer prescription drug coverage to certain demographics – low income Canadians or seniors, for example – but still, one in five Canadians report that they or a member of their households do not take medications as prescribed because of cost.
The consequences, as we all know, can be devastating.
Here's a way to fix it: Canada should develop a carefully curated list of "essential medicines."
The World Health Organization (WHO) has already developed a model list of essential medicines, which is designed to meet the core health needs of people around the world. The WHO recommends that nations adapt the list of medicines to local circumstances and facilitate easy access to all of their citizens.
A number of countries already have already taken on that challenge, including Sweden, India, Armenia and Zimbabwe. Adopting a similar list in Canada would mean that various levels of government would cover the cost of essential medicines — such as insulin (for diabetes), levothyroxine (for thyroid disease) and risperidone (for schizophrenia) — easing the financial burden on everyone.
Many will certainly question how our government, already struggling with the financial pressures of an aging population, could afford to pay for essential medicines. But a short list of medicines could actually help us save money by focusing competition on a small number of products that we could collectively purchase in larger quantities. Less could mean more bargaining power, which could see Canadians save an estimated $3 billion per year.
In addition to providing patients with critical medications when they need them, an essential medicines list also helps make sure patients are getting the right medicine.
As it stands now, more than 10,000 pharmaceutical products are currently approved for sale in Canada. Public formularies, which determine which medicines to fund for some groups (welfare recipients, people with disabilities and older adults) contain three to five thousand medicines. That's a lot of information to track.
With a short list of a few hundred essential medicines, there is less of a chance of error when it comes to writing appropriate prescriptions because patients, doctors and pharmacists only need to know about a relatively small number of medicines.
Critics might argue that an essential medicines list could limit choice and access to important new prescription medications. But we may not have as many "choices" as we think today.
Are we offered "choice" when the list of products is so overwhelming that health practitioners can't possibly keep up? Prescribing decisions too often end up based on the beliefs and habits of the health practitioner holding the pen – which might be based on the best available evidence, but is often based on messages in pharmaceutical marketing campaigns.
When was the last time a doctor explained the pros and cons of each of the 11 different ACE inhibitor blood pressure medicines, and asked his or her patients which one they would like to take? What would the doctor even say, given that there are no important differences between the medicines?
Governments often have a tough time saying "no" to drug companies that have made a product that is similar to a previously approved drug because they might be asked, "Why did you approve that company's product, but not ours?" The result is that these "me-too" products proliferate, and we end up with a large number of medications that do the same thing.
The people who cannot afford medicines now are already forced to make different choices. Food or medicines? Nobody should have to decide whether to pay the rent or to take a life-saving medication for high blood pressure, diabetes or HIV-AIDS. And that's happening today in Canada.
Prescription medicines only deliver on their intended benefits when they are accessible and prescribed and taken appropriately. Developing a list of essential medicines in Canada and publicly funding them could promote progress on both fronts.