National pharmacare - getting it right

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:

  1. Universal first dollar coverage for all residents of Canada
  2. Comprehensive coverage for medicines on a national formulary
  3. Accessible so the plan can be accessed without financial barriers
  4. Portable coverage for residents who travel or move within Canada
  5. 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

Feedback

Is national pharmacare important to you? Please provide your comments and questions below.

 

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  • Nancy Harela
    commented 2019-07-15 17:56:54 -0400
    Hello Jane..
    I would personally appreciate you fighting for total coverage of essential medicines. I have to admit, I didn’t really take notice when then Premier Wynne passed a universal prescription bill for children as my kids were very healthy. But soon after, in Jan/19, my 10yr old was diagnosed with Type 1 diabetes. Her first prescription from her Endo. took approximately 1 hour to fill and cost us nothing. Thank you Ms. Wynne. Fast forward one month and Premier Ford has erased this. She needs insulin to live. She needs a CGM because she doesn’t recognize her ‘Lows" which could be deadly if not treated. My husband’s small business (3 employees) health plan caps her CGM. We will have to pay over that amount. Her sensor is 120.00/week x 52 weeks, and 300.00+ every 3 months for the transmitter and we are way over the cap. Please consider providing universal coverage of Type 1 Diabetic’s CGMs and insulin. I shudder when I think about having to pay $500.00 for a vial of insulin if big Pharma follows suit of it’s American manufacturers. I shudder when I think about any possibility of our Canadian supply, her supply of insulin running dry or low as Americans cross-border shop for insulin. But that’ s another issue. Thank you for reading and good luck!
  • Tom Perry
    commented 2019-07-03 18:24:38 -0400
    I would like to know whether Dr. Philpott supports mandatory disclosure by pharmaceutical manufacturers and medical device manufacturers of all payments to doctors and other health professionals (as in USA and many European countries).

    Tom Perry MD
    Vancouver
  • Bob Kirby
    followed this page 2019-06-16 03:32:25 -0400
  • Charlie Thompson
    commented 2019-06-13 14:50:30 -0400
    I’m so pleased you wrote this. So few people understand what a strange world our pricing and reimbursement regime is, but I’ve yet to find someone outside industry who isn’t outraged when it’s explained to them. PMPRB is obscure, even in health circles, but the new regulations are long overdue.

    Pharmacare is indeed critically important, but I’m worried that the emphasis on PMPRB has waned since you departed as Health Minister. I participated in consultations in the summer of 2017 and understood the regulations would come down in January, but it seems they were tabled for being seen as prejudicial to industry. It warms my heart to know this still matters to you and I’m sure that I’m not alone.
  • Jack Hopkins
    commented 2019-06-13 13:19:37 -0400
    If the UK can do it for all their citizens, why can’t we? Excellent piece on such a timely topic!
  • Bianca Carvalho
    commented 2019-06-13 10:27:37 -0400
    Honestly, I think national pharmacare is a necessity. People are very concerned about the “how much is that going to cost?” Issue, and it’s understandable. Canadians pay a lot of taxes already and are hesitant about that. But also, some countries out there have the system where you pay your monthly taxes and you have a range of free medications (such as hypertension, diabetes, and many other medications for diseases and conditions that people often have). In the end, it’s much cheaper for the government to buy and offer those drugs to the people than if people bought it themselves. But In order to be supported by all – or by most- it’s important that the benefits are shown and explained to Canadians. Right now, everything’s a little too confusing for the average worker that watches the news and see fancy terms to understand and also, the federation must address the high prices medication situation and acknowledge the serious problem that many have with paying 600 dollars a drug that one has to take every month/week. These people probably expect to be assisted somehow by the pharmacare as well. I, personally, am looking forward to hear more about that subject. I find it to be of real importance and surely hope to see it become action instead of only words by the government. Let’s see what will happen next!
  • Jane Philpott
    published this page in Blog 2019-06-13 07:27:14 -0400

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