Op-Eds

Two ways forward for national pharmacare

Colleen M. Flood, Bryan Thomas, Patrick Fafard and Asad Ali Moten | November 14, 2018

The case for universal pharmacare is compelling and clear-cut. But as the federally appointed advisory group led by former Ontario health minister Eric Hoskins prepares the blueprint for a national plan, Ottawa must brace itself for negotiations with the provinces and territories.

Canada is the only OECD country with universal health insurance that does not include prescription pharmaceuticals. One in five Canadians reports that they or someone in their household are not taking their medicine as prescribed, owing to concerns about costs. Although provinces provide coverage for some groups, including the poor and elderly, up to 20 per cent of Canadians have no drug insurance at all. Our limited access also doesn’t save us money: Canada has among the highest per capita drug expenditures in the OECD. This patchwork mix of public and private drug programs leads to access gaps and high costs that threaten the health, and the very lives, of thousands of Canadians annually.

But it doesn’t have to be that way. Ottawa and the provinces and territories have the chance to change lives with a robust, Canada-wide pharmacare program.

A clear set of objectives is essential for a successful outcome of negotiations between Ottawa and the provinces and territories. To be sure, there are many challenges. We need look no further than the bitter federal-provincial talks over health funding to recognize the delicate nature of such negotiations.

Complicating matters even more, governments have overlapping, and at times confusing, jurisdiction over health care under Canada’s constitution. As the Su­preme Court has clearly and repeatedly indicated, which level of government has pri­mary jurisdiction depends on the particular issue at hand.

Currently, the federal government exercises some of its constitutionally mandated powers to shape and direct pharmaceutical policy—playing a larger role in this domain than with respect to other parts of health care. This includes the regulation of patents and safety and efficacy of medicines. It also funds prescription drug benefits for specific populations, such as prisoners, members of the Armed Forces and the RCMP, and veterans.

Arguably, this provides a foundation for ­Ottawa to take a far stronger leadership role in the establishment of universal pharmacare than it has to date. In our recent study for the Institute for Research on Public Policy, we outline two constitutionally viable policy options for a national pharmacare framework.

Under the first option, the provinces would agree to delegate the power to administer drug insurance plans to a federally funded agency. This process was used to establish Canadian Blood Services in the 1990s. Through public tendering and bulk purchasing, the CBS has been able to achieve dramatic cost savings for certain pharmaceuticals on behalf of the provinces. Its success shows that intergovernmental collaboration to implement universal delivery of health-care products can be achieved where sufficient political will exists.

As a second option, the federal government could adopt legislation similar to the Canada Health Act and provide annual transfers for pharmacare to the provinces and territories. The funding would be contingent on compliance with two criteria: (1) universal coverage for a basket of essential drugs, with no copayments or deductibles; and (2) decisions over what to include in the basket to be made by an arm’s-length body (or bodies).

The forces in opposition to change are extremely formidable, including private insurers and pharmaceutical companies. There will be repeated calls that the status quo is not that bad and only minor changes are required.

We should learn from the experience of the United States health-care system, that the “fill-the-gaps” approach is mere code for more of the same: high prices and problems with access. It is imperative that the federal government makes a firm commitment to leading the country toward universal pharmacare. In negotiations with the prov­inces and territories, Ottawa’s bottom line must be ensuring the overarching principles of univer­sality and accountable decision-making.

Colleen M. Flood, Bryan Thomas, and Patrick Fafard are professors of health policy and law at the University of Ottawa Centre for Health Law, Policy & Ethics. Asad Ali Moten is a freelance legal researcher in Toronto. They are authors of Universal Pharmacare and Federalism: Policy Options for Canada, published by the Institute for Research on Public Policy.

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