examining models for a national pharmacare program
TRANSCRIPT
3SIXTY PUBLIC AFFAIRS OTTAWA | TORONTO | MONTREAL
CCSN Webinar National Pharmacare
June 18, 2015
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What we will discuss
1. Historical overview
2. Growing attention on the issue
3. Recent national pharmacare roundtable
4. Support at the federal level
5. Arguments raised by proponents
6. Concerns raised by critics
7. Various options on the table
8. Guiding principles
9. Questions
1964Hall Commission
1960s 1980s 1990s 2000s 2010s 2020s
Canada Health Act1984
National Pharmaceutical Strategy2004
2002Roy Romanow’s Royal Commission on Health Care Report
National HealthForum1997 Federal election
Oct. 19, 2015
Background / history
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Growing attention on the issue
1) Increased policy calls• Professor Steve Morgan (UBC) and Dr. Danielle Martin (physician and VP at
Women’s College Hospital in Toronto) • 2015 article on the cost of universal national pharmacare in Canadian Medical Association Journal
• Professor Marc-André Gagnon (Carleton University)• 2014 position paper for the Canadian Federation of Nurses Union (CFNU) entitled “A Roadmap to a
Rational Pharmacare Policy” • Canadian Health Coalition, CFNU and Canadian Doctors for Medicare
2)Political support at the provincial level• ON Health Minister Hoskins strongly supports pharmacare (raised the issue at
Health Minister's Meeting in fall 2014, wrote opinion pieces in Globe & Mail and Toronto Star and recently held a roundtable on the issue)
• NS Health Minister favours pharmacare• QC Minister supports if the federal government funds it
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National pharmacare roundtable• Roundtable in Toronto on June 8, 2015 hosted by
Minister Hoskins of ON• Attended by health ministers from BC, SK, MB, NB,
NFLD, NWT and Minister for Rural and Remote Health in SK, plus advocates and academics
Joint Statement by Ministerial Participants of Pharmacare Roundtable
Today we continued the conversation from last fall's Health Ministers' meeting and met with academics and experts from across Canada to discuss the possibility of pan-Canadian pharmacare. …Areas of exploration included hearing about the costs, benefits and challenges of universal access to drugs, the experiences of various jurisdictions and the impact of a pan-Canadian program.
This is neither the beginning nor the end of this discussion. To better inform ourselves with the evidence, we are determined to seek advice and input from other voices who can offer guidance and advice as we move this conversation forward.
As ministers of health, we will continue these discussions both at tables like this and within our own jurisdictions to work towards our common goal of improving access to health care.”
NFLD Health Minister Steve Kent: “I think a lot of us agree on where we want to get, but I’m not sure anybody fully understands yet how we’re going to get there.”
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Support at federal level• NDP is calling for national pharmacare
• Federal Liberals are open to discussing pharmacare. At CARP meeting in October 2014, Trudeau stated the following:
• Harper Government unlikely to support national pharmacare
“Yes, we are very very interested in looking at pharmacare. The reality is that we don’t’ have the same kind of fiscal situation that the Liberal government left with when we left office in 2005- 2006. We had a $13 B surplus. We’re finally just getting back into surplus. There will be some difficult decisions to be made but I certainly know that partnering with the provinces, looking into how we can make health care and pharmacare more affordable, prescription drugs more affordable, particularly for our most vulnerable people, is a priority for the liberal government.”
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Arguments raised by proponents
• Prices: Canada has high medication prices and more savings could be achieved through a single public payer by relying on bulk buying for generics, increased negotiation leverage for innovative products and reduction of administrative costs • $7.3 billion in annual savings according to Professor Morgan• $11.4 billion in annual savings according to Professor Gagnon
• Affordability individually: 1 in 10 Canadians aren’t filling prescriptions due to cost
• Sustainability of public and private plans• pan-Canadian Pharmaceutical Alliance (pCPA) has limitations:
e.g., negotiation leverage not as strong as with only one payer• Lack of equity: reimbursement varies from one province to another• Won’t affect pharmaceutical R&D
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Concerns raised by critics
• Standardization has drawbacks (i.e., less flexibility/ choices and risk of lower common) denominator)
• Coverage is already adequate for most Canadians and gaps can be addressed
through other measures• Provinces already achieving savings through pCPA and prices /
spending are sustainable• Priority: fix problems with existing health system (e.g., access
to family doctor) before creating new program• Increased cost to government/tax payers and uncertainty raised
around potential overall savings to healthcare system • Could negatively impact pharmaceutical R&D (e.g., access to
clinical trials in Canada)
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Various options on the table• Status quo (i.e., current pCPA)• Federal orphan drug/catastrophic
pharmacare plan• Individual health saving funds for future
pharmacare benefits• Income-based medication coverage
plans• Bulk purchasing of generic medicines• pCPA expansion - e.g., national formulary for certain
medications• Quebec model - mandatory coverage with public/private mix• Managed competition scheme - universal private scheme• Universal national insurance plan with first dollar coverage
and one single public payer
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Guiding principles• The Canadian Pharmacists Association released a
statement focusing on the core principle that “all Canadians should be able to access medically necessary medications, regardless of income”
• Prof. Jeff Dixon (Queens U) mentions that any model should be evaluated against the following criteria: • financial sustainability• equity• individual choice • national pricing• multijurisdictional authority
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Questions• What are the barriers to access to medications?• How can these barriers be addressed (i.e., how could the current system be enhanced/changed)?
• What measures can be taken to improve timely patient access to medications?
• What principles should guide any changes to drug programs including any potential national pharmacare plan?
