Time for pharmacare now

A national pharmacare program is both do-able and a cost saver for Canada. @NightshiftMD has two important studies.
Though Canada is a country that prides itself on its Universal Health Care plan, across the country, Canadians ration their medicine, do without other necessities, or simply go without their pills. (Getty Images/Darren McCollester)

Studies show one in ten Canadians can't afford prescribed medication, prompting calls for a universal pharmacare program.But some say Canada can't afford that, either. Two studies just published by the Canadian Medical Association Journal say otherwise.

If Canada and the provinces were to continue with 'business as usual,' it would continue to be very expensive. There are many problems with the current system, but the main one is that we have a patchwork of private and public financing of medicines makes little sense medically and money-wise. 

Steve Morgan is a Professor in the School of Population and Public Health and Director of the Centre for Health Services and Policy Research at UBC.  He's also a strong advocate for universal pharmacare program.  In the first of two studies, Morgan and colleagues did some number crunching of the cost.  If we put all Canadians into one universal plan, it would save the patients and private drug plan sponsors on average $4.27 billion per year. The incremental cost to the government would be just $1.23 billion per year. 

The bottom line is that Canada could cover more people at an affordable cost.

The first and most important step would be to create a list of essential prescription medications.  The World Health Organization (WHO) has a model list of essential medicines that is updated every 2 years.  The WHO list contains 448 drugs. By comparison, there are provincial formularies that have as many 7000 medications.  Using the WHO list as a starting point, Dr. Nav Persaud, a researcher at St. Michael's Hospital in Toronto, led a team that consulted with colleagues to create a smaller, made-in-Canada list of just 125 medications.  They pruned the WHO list by removing similar drugs from the same category, as well as drugs for conditions not common in Canada. 

Even so, the pruned list includes the gamut of prescription drugs: antibiotics, blood pressure medications, antidepressants, drugs for epilepsy and insulin.  In the study by Persaud, that small list of medications covered well over 90 per cent of medications prescribed at two large family practice clinics in Toronto.

By banding together, Canada would use bulk purchasing to get drug prices that are comparable to other countries. Bulk buying has begun in Canada to some extent, but the pace has in my opinion been too slow.   

According to figures in Steve Morgan's paper, generic versions of the essential medicines on Canada's would-be list were priced 53 per cent lower in the US, 56 per cent lower in Sweden and 84 per cent lower in New Zealand.  A small list of high-volume medicines was at least 70 per cent cheaper in two or more countries compared to Canada.  These include the cholesterol lowering drug atorvastatin, the peptic ulcer drug pantoprazole, and the blood thinner clopidogrel. 

Almost half of the estimated total national savings from adding universal public coverage of essential medicines would come from just seven categories of common prescription medicines. 

Canada's record of negotiating cheaper prices has been appalling. 

A report last year by the Patented Medicine Prices Review Board (PMPRB) found Canada's generic drug prices are 19 to 31 per cent above prices in Europe, the U.S., Australia and New Zealand.  According to a report in the National Post, the provinces don't actually bargain for the cheapest price. Instead, they pay a percentage of the cost of the original patented drug.  The Post gave the example of the antidepressant venlafaxine. Apotex  a generic manufacturer here in Canada  sells the drug in the U.S. for half the price it does in Canada.  The same generic preparation of the blood pressure medication amilodipine is sold to New Zealand at a tenth of the cost paid by Canadian provinces.  Countries like Sweden and New Zealand aren't afraid to shut out from the market generic manufacturer that refuse to mark prices down.

A year ago, I would have thought that the federal government had too much on its plate to even consider pharmacare.  Just last year, federal Health Minister Jane Philpott told doctors at the annual meeting of the Canadian Medical Association that pharmacare was years away. But last month, the minister told the Fifth Estate that the current situation is unfair, and vowed to fix it. She acknowledged that Canada pays much higher prices than other countries.  She said, "Canadians are going to see that we are going to be able to save [them] in the order of billions of dollars per year."

That sounds like a promise to me.

When you see Canada kick butt with drug makers, you'll know that pharmacare is coming.


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