Montreal—The federal Liberal government and the NDP have set a March 1 deadline for passing legislation to implement a national pharmacare plan. A new publication from the Institute for Research on Public Policy provides decision-makers with a roadmap for how best to implement universal pharmacare in Canada.

In National Pharmacare: Laying the Groundwork, co-authors Michael Law and Fiona Clement call for a fiscally prudent staged approach, starting with a reinsurance plan run by the federal government that would cover high-cost medications for rare diseases. This would be gradually expanded until a full and comprehensive program of consistent, universal public drug coverage is in place.

The authors identify five features that a federal reinsurance plan should include that would make it comparatively inexpensive to introduce, and that would ensure that future spending by governments is adaptable and predictable:

• A value-based list of drugs: This would begin as a small list of expensive drugs for rare diseases, expanding over time to a comprehensive list of high-value medicines.
• First payer: The federal plan would pay for eligible prescriptions before all other insurance plans. At the outset, it would pay for covered prescriptions above a high threshold. Over time, this threshold would be reduced to provide additional financial assistance.
• Copayments: The plan could be designed to include or exclude copayments for prescriptions over the reinsurance threshold, depending on the available budget.
• Full coverage for lower-income groups and higher thresholds for higher-income groups: The plan could provide generous exemptions to cost-sharing for people with lower incomes. Those with higher incomes could have a higher threshold.
• Coverage escalator: The threshold above which drug costs are reimbursed would increase over time, making the eventual public plan universal and comprehensive.

These features would help improve access to medicines, increase equity in the system and improve how drugs are prescribed and used in Canada, the authors say. At the same time, it would overlap with existing systems of drug coverage and minimize disruption.

“This is the most practical approach that maintains universality as a core principle,” say Clement and Law. “Our proposal builds on existing momentum and will create a platform from which further progress could be made. In the current political context, we believe it is crucial to take a meaningful step toward national pharmacare and not lose this opportunity for progress.”

National Pharmacare: Laying the Groundwork can be downloaded from the IRPP’s website (irpp.org).