White Coat, Black Art·White Coat Black Art

Swedish Pharmacare: "I'm so glad I'm paying taxes to give you this medicine."

Dr. Brian Goldman travels to Stockholm to look at its pharmacare system.

White Coat Black Art

Swede's pay a maximum of $350 per year for prescription medicine. After that, the government picks up the tab. (PATRIK STOLLARZ AFP/Getty Images)
Listen to the full episode27:30

​Dr. Brian Goldman travels to the land of Minecraft and IKEA, to look at Sweden's pharmacare system.

When you go to get [your medication] in the pharmacy, you can see on the box the cost of the medicine. Every time you get them, you know what you don't have to pay.- Eva Johansson

In Sweden, patients pay no more than $350 Canadian per year for their drugs. For patients like Eva Johansson, that's a fraction of the cost of the drug, Enbrel, she takes to keep her rheumatoid arthritis in check.  

Swedes pay for pharmacare with very high taxes. Johansson says her friends are glad to pay taxes that give her access to her medication. A decade ago, a right-of-centre party came to power on a platform of lower taxes. When programs and services were cut, Swedes said no thanks.

Eva Johansson takes Enbrel, which in Canada costs $1800 a month. She pays the equivalent of $350 Cdn a year for all her prescription drugs.

Brian talks to Bjorn Wettermark, head of analysis for the regional health board in Stockholm, Sweden's largest public buyer of prescription drugs. He says that to keep pharmacare costs under control, the government chooses generic drugs whenever possible. He says that Sweden's typical cost for patent-expired generic drugs is less than ten percent of the same brand-name drug. They're also big on objective clinical evidence. Drugs like Enbrel, with their transformative improvements in patient health, make the cut because they're proven to work.  

Dr. Dag Ström is a pediatrician and patient-safety expert who is concerned about over-prescribing amongst Swedish patients.

Magnus Thyberg who runs the prescription reimbursement system for Stockholm, describes a monthly auction system in which drug companies continually compete with each other for the right to supply drugs to the government. It's a simple system that Thyberg says ensures rock-bottom prices.

Christina Kennedy, editor in chief of Dagens Medicin, says Swedes sometimes struggle with balancing the needs of individual patients with the sustainability of the system.

Keeping prices low means making tough choices. Christina Kennedy of Dagens Medicine, a newspaper that covers Sweden's healthcare system, says that Swedes struggle with grey areas, such as the government refusing to pay for drugs that might improve quality of life in terminal patients. They know it's best for the system, but balk when someone they know is refused a drug.

Others are critical of flaws in the system. Dr. Dag Strom, a pediatrician in Stockholm and an expert on patient safety, says in Sweden it's easy for patients to go to different doctors and get multiple prescriptions, which may interact with each other and land them in hospital.

There are also concerns about the sustainability of Sweden's pharmacare. Some of the newest treatments entering the markets -- expensive cures for hepatitis C, new cancer drugs -- could tip the scales against pharmacare.


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