I am delighted to see the Final Report of the Advisory Council on the Implementation of National Pharmacare. Overall, it’s a great report. I strongly support universal single-payer public pharmacare to ensure that Canadians have fair access to medically necessary medication. This is a wise investment that will save money and prevent unnecessary illness for Canadians. Pharmacare is one of a few pieces of unfinished business in Canada’s cherished system of Medicare.
Today’s report aligns with a long list of previous studies including the approach recommended by a diverse coalition representing health care providers, non-profit organizations, workers, seniors, patients and academics. It envisions a system of pharmacare that functions in harmony with the principles of the Canada Health Act. It would be governed by the following principles:
- Universal first dollar coverage for all residents of Canada
- Comprehensive coverage for medicines on a national formulary
- Accessible so the plan can be accessed without financial barriers
- Portable coverage for residents who travel or move within Canada
- Public single-payer administration with bulk procurement to maximize purchasing power
I commend the Advisory Council on great recommendations. In the federal election, I hope all parties develop platforms with this report in mind. Most of all, I hope the recommendations will be implemented, ideally in a time frame shorter than the report envisions.
Perhaps in the best-case scenario, we will have a minority government in which independent Members of Parliament will help hold the government to account in order to achieve big initiatives like national pharmacare. Recall it was in 1966 during the second minority government of Lester B. Pearson that national Medicare was launched through the legendary vision of Tommy Douglas and support across all parties.
I have a few concerns about the future of national pharmacare that were not heavily emphasized in today’s report. My biggest concern is with the price Canadians are paying (publicly and privately) for medicines.
The current federal government made a commitment to act on pharmaceutical pricing. Some progress was made when the federal government joined the pan-Canadian Pharmaceutical Alliance. It was one of my first actions as Minister of Health in January 2016. This bulk-purchasing arrangement now leads to public savings of close to a billion dollars per year.
But there has been no progress at all on reform of the Patented Medicine Prices Review Board (PMPRB). The PMPRB was created in 1987 to protect consumers and make sure pharmaceutical companies don’t use monopolies to charge excessive prices.
In May 2017, when I was Minister of Health, I announced consultations on a suite of regulatory changes that would help the PMPRB in its ability to protect consumers from high drug prices. You can watch my speech from that announcement by clicking here.
These were to be the first substantial changes to the regulations in over 20 years. It included a proposal to change the list of countries to which we compare our medication prices. (By continuing to use the USA as a comparator country, we allow inappropriately high ceiling prices.) We also proposed that value for money should factor into determining a fair drug price. And we proposed a requirement to report rebates, discount and refunds to payers, in order to increase transparency and set a fairer price ceiling. I wanted those new regulations in place no later than the end of 2018. But unfortunately, this has not happened.
The Advisory Council mentions this briefly in Recommendation #59: “The council recommends the federal government advance efforts to strengthen the Patented Medicines Regulations to lower the prices of patented drugs for all payers.” I wish that were written with the boldness and strength it merits.
National pharmacare is an essential step in caring for Canadians. But it must be accompanied by good stewardship of public funds. Unless the government proceeds with the PMPRB reform, they will be locking in excessive pharmaceutical prices when Canadians already pay the third highest (per capita) prices in the world. I have heard no good reason why they are not proceeding with the proposed changes now.
For more information on drug prices, see these two great articles:
The strange world of Canadian drug pricing by Andrew Boozary and David Naylor
We need innovation in our drug price regulations by Steve Morgan
Is national pharmacare important to you? Please provide your comments and questions below.