Access To Medicine And The Hopes For National Pharmacare
Education and Advocacy 2015 was a watershed year for innovation in medicine. The US Food and Drugs Administration approved 45 new drugs last year, the most since 1996, and Health Canada approved nearly as many.
Yet for many Canadian patients, the wave of medical breakthroughs is out of reach. As one Montréal patient with brain cancer notes, “my feeling is that in Canada we have exceptional care, but we don’t have great access to ‘new’ drugs.”
Access to innovation
To Canadians, this feeling is both familiar and strange: familiar, as it mirrors oft-heard anecdotes about American cancer patients relying on friends, family, and charitable strangers to finance expensive medical treatments; and strange, as Canadians (and others around the world) tend to believe that we enjoy universal access to health care.
Brett Skinner of Innovative Medicines Canada notes that the real problem with drug insurance in Canada is that existing public drug plans are under-insuring patients, potentially affecting the health outcomes of over 11 million Canadians. Canada’s public drug plans lag other developed countries’ when it comes to access to new medicines. Of the 141 new medicines approved by Health Canada from 2009 to 2013, only 23 percent received public reimbursement across provinces accounting for at least 80 percent of the eligible national public drug plan population, ranking Canada 17th of 18 Organisation for Economic Co-operation and Development (OECD) countries. For the new medicines that were covered, the wait for reimbursement averaged 462 days, ranking Canada 16th of 18 countries. Finally, Canadian public drug plans placed restrictions on reimbursement for 90 percent of the new medicines that were covered, ranking Canada 14th of 17 countries.
Deb Maskens, kidney cancer patient and co-founder of the CanCertainty Coalition, agrees that gaps in coverage “need to be closed, especially when it comes to access across provinces for take-home cancer drugs. Cancer treatment must include take-home medicines.”
One proposed solution, advocated by Dr. Eric Hoskins, Ontario’s Minister of Health and Long-Term Care (MOHLTC), calls on the federal government and the provinces to implement a national pharmacare program, so that all Canadians can access the same list of drugs. Arguing that such a national approach would lead to potential savings of up to $11.4 billion each year, Hoskins claims that pharmacare is the natural next step in the evolution of Canada’s most revered symbol — universal health care.
“Patients must be at the table for all aspects of federal-provincial discussions on a new health agreement.”
Other Canadians doubt that much money would be saved and worry that access might even become more limited. The Canadian Pharmacists Association (CPhA) recently commissioned a study on the issue. The study concluded that a universal model would address the 10 percent of Canadians currently unable to afford their prescriptions, however it would also cost taxpayers an additional $6.6 billion per year. The study also suggested that the plan could dramatically decrease the number of medications currently covered, and increase wait times for new medications to receive coverage.
“We believe that all Canadians should be able to access necessary medications, regardless of income or postal code. However, a universal pharmacare model is only one option that Canadians should consider,” says CPhA Chair Carlo Berardi.
Berardi notes that spending on drugs in Canada accounts for only 15 percent of overall health care expenditures. “What about the other 85 percent of health care costs? The conversation around pharmacare needs to be about how we can reduce hospitalization rates and ER visits and achieve better health outcomes through improved access to optimal drug therapy.”
Access begins with patients
Deb Maskens is encouraged by the new attention on healthcare. For Maskens, “the new Federal Health Accord is a great place to start, and should lead to improved access and greater consistency for all Canadians, regardless of where they live. Patients must be at the table for all aspects of federal-provincial discussions on a new health agreement.” She believes that “whatever form pharmacare takes, as long as it achieves improved access to necessary medications, patients will support it.