Pharmacare, Sweden-style

Prescriptions that cost a fortune in Canada are offered free of charge in Sweden, or almost. I visited Stockholm to see the system for myself.
  Canada is the only industrialized nation that pays for health care but not for prescription drugs.  This Tuesday, White Coat, Black Art is hosting Politics & Prescriptions: Should Canada Pay for a National Drug Plan, an election town hall looking at prospects for pharmacare in Canada. You'll hear the highlights on program this weekend.  Last week, I had a chance to check out Sweden's prescription drug program for myself.

It's called the national prescription reimbursement program. The doctor writes a prescription, and the pharmacist checks to see if the medication is on a list of the least expensive medications deemed safe and effective - selected by a panel of experts based on evidence.  If your prescription is on the list, it's covered.  If your doctor prescribes a more expensive brand name drug, the pharmacist automatically substitutes the cheaper alternative.  If your doctor insists on the pricier medication, he or she can ask for an exception; if denied, the patient can pay the full cost of the costlier drug.

Under the Swedish system, prescriptions aren't completely free of charge.  You pay a small user fee called a co-pay. The co-pay fee goes down the more prescriptions you receive.  Once you reach a total of 2,200 Swedish Krona ($350 Canadian) in a calendar year, everything else is free of charge.  Rich or poor, the rules are the same. 

Speaking of rules, when Sweden pays for costly drugs, it's because evidence shows the drug extends life or dramatically improves the quality of life.  They don't respond to emotional pleas. 

Canada frowns on user fees because experts here say they discourage low income people from seeking care.  But in Sweden, user fees are a reminder that medications aren't free.  And when Swedes pick up their meds, they see the actual cost paid by the state.

The program is generally well received in Sweden. There are no calls to dismantle it. That's despite the fact that Sweden's tax rates are very high. The top marginal tax rate was recently raised to 60 percent, and Sweden's GST (Value Added Tax or VAT) is a whopping 25 percent.  A few years ago, the government brought in tax cuts; but, after cuts to programs and services, Swedes figured the tax cuts weren't worth it.

  The people most satisfied with pharmacare are those who get expensive drugs.  Eva Johansson is 55 years old, and has rheumatoid arthritis. For the past three years, she's been taking a drug called Enbrel.  The cost of the drug in Canada is about $1800 a month.  In Sweden, Johansson gets it for free. 

"I would probably feel life slipping away," said Johansson.  "I would lose contact with friends because I wouldn't have the energy to see them.  I wouldn't be able to travel."

Sweden has long paid for prescription drugs, In 1999, it looked at the trend line and saw that drug costs would consume the entire budget. So, they took a very tough approach with drug companies.  They made substituting the cheapest generic drug automatic.  They forbade drug company reps from visiting doctors and sent their own experts instead. They also forced generic drug makers to underbid each other to provide drugs at rock bottom prices. 

  Canada has much to learn from countries like Sweden.  I think we should follow Sweden's example and put in automatic prescribing of cheaper generics, and get much better at negotiating lower generic prices.  We also need to get tougher about providing expensive drugs only to those who clearly benefit from them.  Even if Canada does all that, it doesn't guarantee the system is sustainable. Costly new drugs for cancer, hepatitis C and others will put even more pressure on a system that is already under strain.  We'll be discussing all of these and more on our town hall edition this week.

You can hear a broadcast of our town hall on White Coat, Black Art, Saturday October 3 and Sunday October 4 on CBC Radio One and Sirius XM. 

Note:  If you live in and around Toronto, we're taping our town hall on Tuesday, September 29 at Glenn Gould Studio 250 Front Street right beside the CBC Broadcasting Center.  Doors open at 7 pm and it's first come, first seated. Hope to see you there.


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