Canada should have universal, single-payer public pharmacare, says advisory council

Canada should have a national pharmacare program that is universal, single payer and public, says an advisory council tasked with studying the possibility.

The Advisory Council on the Implementation of National Pharmacare made this statement in its final report, released Wednesday morning. The council, which was asked last June to look into the issue, says this kind of program will result in better drug coverage for Canadians and save individuals and governments money.

“This is our generation’s national project: better access to the medicines we need, improved health outcomes and a fairer and more sustainable prescription medicine system,” said council chair Dr. Eric Hoskins in a press release.

Here’s how the council thinks the program should work:

All Canadians would have access to a list of drugs from a national formulary. Drugs on the essential medicines list would carry a co-payment of $2, while other drugs would cost $5. No person or household would pay more than $100 per year.

People on social assistance, the federal Guaranteed Income Supplement or federal disability benefits would be exempted from the co-payment.

Creating this kind of plan would remove the need for a lot of current private drug insurance — something the council believes would save Canadians and businesses money as well as provide more employment mobility, as people would always have minimum drug coverage.

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Provinces would implement the program according to federal standards, the council says. It recommends creating a new federal funding transfer for this purpose, so that the federal government would foot the bill for the additional cost of this program.

“As with medicare, it will be up to individual provinces and territories to opt in to national pharmacare by agreeing to the national standards and funding parameters of pharmacare,” the report reads.

And while the government should start working immediately with willing provinces, the report’s authors note that some jurisdictions “may take longer than others to join national pharmacare.”

Health Minister Ginette Petitpas Taylor thanked the advisory council for its report, but did not explicitly endorse the plan. Nor would she rule out a more limited “fill-in-the-gaps” approach, which would provide drug coverage only to people who don’t currently have it.

“Over the coming months, we will carefully review the council’s final report and its recommendations,” she said. “We look forward to continuing to work closely and collaboratively with the provinces and territories and with our partners and stakeholders as we consider next steps.”

“I want to be very clear, however, that our government is committed to making sure that all Canadians have access to a national pharmacare program.”

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Implementing this program would take years, though. The council envisions that the government would start by creating an agency to implement a national drug formulary. The council believes the agency would have a list of essential medicines that Canadians could access by 2022.

A full drug formulary might not be in place until 2027, the report suggests.

As legislation could not pass before the next federal election, Hoskins said, “I believe it will be part of the next election campaign.”

Petitpas Taylor said that more information on the Liberal approach would come out in the government’s election platform. The NDP has already endorsed a national pharmacare plan.

This program will cost an additional $3.5 billion in 2022 with the limited formulary, according to the report. The full program, implemented by 2027, will cost $15.3 billion per year.

But escalating drug costs mean that Canada needs to negotiate drug prices as a national entity, Hoskins said. Last year, Canada spent around $34 billion on prescription medication, according to Hoskins, and by 2027, that could rise to $55 billion under the current model.

“The price is too high not to do anything,” he said.

Petitpas Taylor agreed. “We certainly recognize that the cost of doing nothing is just going to be astronomical,” she said.

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“Although national pharmacare requires a substantial investment of public funds, it will result in significant savings to Canadian families and lower the total amount being spent on prescription medications,” reads the report.

It estimates that Canadian families will save an average of $350 per year on a national pharmacare program, and business owners will save $750 per employee.

Currently, Canadians rely on a patchwork of provincial and private drug plans to pay for prescription medicine. According to the report, around one in five Canadians reports having trouble paying for medication.

Canada is the only country with universal health care that does not have universal drug coverage, the report says.

Petitpas Taylor said that while her government was committed to ensuring access to drug coverage, there is a lot of work ahead. “I think we have to keep in mind that putting together a national pharmacare program, if it was easy, I think many governments would have done so in the past.”

‘Extremely happy’

Representatives from the medical community reacted positively to the council’s recommendation for national pharmacare.

Linda Silas, president of the Canadian Federation of Nurses Unions, said she was “extremely happy” to hear the news. “What it will mean for nurses is patients will get the prescriptions they need. So they won’t be admitted or readmitted,” she said.

“We won’t be stealing or borrowing samples to give to patients. They will be getting what they need and that’s what’s important.”

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Her organization intends to push politicians to adopt the recommendations.

So does the Canadian Medical Association.

“The scalable single payer model proposed by the advisory committee will provide an opportunity to achieve savings, consistency and equitable access for all Canadians,” said CMA president Dr. Gigi Osler in a statement. “The CMA is especially pleased with the recommendation for a low co-payment model, which has been successfully implemented in other countries.”

Osler said her organization hopes that all federal parties will include this report’s recommendations in their platforms for the upcoming election.

Innovative Medicines Canada, a pharmaceutical industry group, also said they approve of having universal pharmacare to make drugs more affordable and accessible to all Canadians. However, in a statement, the organization said they worry that changes to how drug prices are reviewed would discourage new drugs from entering the market.