Canada requires universal and all-inclusive pharmacare based on a 'defined model'

A five-day meeting was held in Ottawa between The Citizens' Reference Panel on Pharmacare in Canada, which comprised 35 volunteers randomly selected from across Canada and 20 experts.

Representatives of the panel presented the report entitled "Necessary Medicines", to the House of Commons' Standing Committee on Health on Dec. 6.

"In public opinion research that's been conducted, Canadians routinely support some form of pharmacare," panel chair Paul MacLeod said. "But that's always been a placeholder. We haven't really had a defined model that Canadians are saying they would endorse. That's part of what this report provides."

The recommendations of the panel included: Creation of a national formulary of universally publicly funded medicines for full range of individual patient needs, including rare diseases, a rigorous evaluation process for all drugs to ensure their cost-efficiency and recommending all private insurers to provide coverage for supplemental drugs.

Canada is the only developed country which has universal health coverage but that does include universal prescription drug benefits.

Canada has the second-highest per capita spending on prescription drugs in the Organization for Economic Co-operation and Development (OECD), OECD says.

Canadians spend almost $30 billion a year on prescription medicines.

According to estimates one in 10 Canadians cannot afford to fill prescriptions.

Colleen Flood, director of the Centre for Health Law, Policy and Ethics at the University of Ottawa, one of the experts who presented to the panel, supported the idea of a Canada-wide pharmacare plan.

"Essentially for pharmaceuticals needed outside the hospital, we pretty much have a U.S.-style system," Flood said.

Under a national plan, Flood said, Canadians could have access to pharmaceuticals at a much lower price, just as medicare does for hospital and physician services.

"Other countries show us that you can have your cake and eat it too," she said. "You can have full public medicare, covering everybody, and you are going to spend less, not more."

A national pharma-care plan would allow governments to negotiate lower drug prices provided they meet the cost-efficiency criteria of the drugs, said Flood.

The panel suggests to begin with a short list of essential medicines comprised of frequently prescribed drugs and to expand this list once a national formulary is ready.

Emily Dukeshire of Calgary was one of the citizen panellists.

"What really motivated me was that there's people who fall through cracks of our system right now. People who are not getting the drugs they need, and it costs the system money because people can stay in the hospital and get drugs for free," Dukeshire said.

The major gap in the current, pointed by MacLeod is, "[Most Canadians are] fortunate enough to have coverage through [their] employer or we've enjoyed good health and we haven't had to pay a lot of pocket. We tend to assume that must be how it is for everybody….for individuals who aren't so fortunate as to enjoy that kind of employer-provided coverage, and those people, of course, who deal with very serious health issues."

Flood agrees that the current system "leaves a gap."

In 1964, a national pharma-care program was recommended originally as part of the Royal Commission on Health Services, also known as the Hall Commission, as well as in later reports, such as the 2002 Romanow Commission.

The reasons for the non-implementation of national pharma-care were that most Canadians had private health insurance through employers and in many provinces cost of drugs for poor and the elderly are legally covered.

MacLeod said the program could be funded by the government through "modest" income- and corporate-tax increases as suggested by citizens' panel.

"Another major reason is none of us want to pay more taxes, but we do have to acknowledge that we are paying taxes now in the form of tax breaks for employers that cover health insurance," Flood said.

Canadian Institutes of Health Research was responsible for funding the research of the panel.

The process was supervised by a committee of clinicians, senior public servants and health researchers from across Canada.

Dukeshire said she was impressed with the process of random selection of the panelists  from about 1,000 volunteers to advise policy-makers on drug coverage for Canadians.

"This whole process was really amazing that we were all so different and from all across the country, and yet we went through this process together and we were able to come up with core values that we all believed. We were able to define some issues and then come up with some solutions together," Dukeshire said.

Other speakers included doctors, nurses, pharmacists, brand name and generic drug manufacturers, health insurers, retailers, patients, public agencies, academics and former policy-makers.

The federal government’s agenda does not officially have a national drug plan as one of its priorities.

(Reporting by Asha Bajaj)

(Image: House of Commons Ottawa Wikipedia)