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The fight for pharmacare in Canada

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Canada is the only developed country that has a universal health-care system but doesn't cover prescription drugs. Not only is this bad fiscal policy, but it has left eight million Canadians without coverage.

In the absence of a national pharmacare program, every province, territory and federal health-care system (RCMP, military, veterans, inmates, First Nation and Inuit) has its own pharmaceutical program. This has led to a patchwork of pharmaceutical insurance plans across the country where different medicines are available in different provinces, eligibility for public coverage differs dramatically, co-pays and provincial/territorial deductibles go from a few dollars to thousands and Canadians in some parts of the country find greater financial barriers to filling their prescriptions than others.

Often Canadians do not know which drugs their province/territory covers and which drugs other provinces/territories cover. While decision-making about which drugs to cover should be based on evidence, the power lies in the hands of politicians who may be swayed in favour of one drug over another by special interest groups such as big pharma. The financial ability of provinces or territories to cover drugs -- especially those not yet off patent -- can be a major influencing factor in deciding which drugs the province is willing to add to their purchasing list.

Currently, Canada's provinces and territories meet individually with the representatives of pharmaceutical giants and negotiate one-on-one to purchase medicine. These negotiations are subject to confidentiality which means one province/territory will not know the price that another province/territory paid for the same drug. Provinces that require more drugs -- often those with bigger populations -- can negotiate more aggressively than smaller provinces. This leaves poorer provinces like those in the Atlantic at a significant disadvantage.

If Canada were like other universal health-care providing countries, we would have one evidence-based drug list and we would bulk-purchase those drugs for all Canadians. This would save us billions of dollars in provincial/territorial, federal and out-of-pocket expenses.

A universal pharmacare program would demand federal oversight and accountability. One of the many positive outcomes of federal involvement could be an ending to the severe drug shortages Canada has been experiencing. If we negotiate with Big Pharma as a national bulk purchaser we may be able to afford to purchase more of the drugs in short supply.

But what is much more important than just the financial argument to pharmacare is the social justice argument. Canada created a national and universal health-care program so that all Canadians could have access to the care they need regardless of their ability to pay. While we currently restrict our public and universal health-care system to hospital and physician services, the Council of Canadians and our allies (including the Canadian Medical Association) are lobbying all levels of government to expand medicare services to include home and community care, long-term care, mental and dental care, and pharmacare.

Without pharmacare. Canadians are not able to afford their prescription drugs. Provinces such as B.C. have a 15 per cent cost-related non-adherence to medicine (for more information see the work of Steve Morgan, University of British Columbia). This means that 15 per cent of those who have been prescribed medicine have to skip pills, cut pills, or not to fill their prescription due to cost. This could leave people having to re-visit their health-care provider, or use emergency rooms to access the care they need and have their medicine provided by the hospital. Not only is this the most expensive way to obtain care, it is also likely to further financially impact the patient as more visits to the hospital results in less time at work and leaves them with less money to afford their next round of medicine.

Expanding the medicare umbrella to cover other medically necessary services like pharmacare would bring Canada's services more in line with every other public and universal health-care system in the developed world, it would save Canadians over $10 billion a year, and it would ensure that everyone has access to the medicines they need.

The Pharmacare 2013 conference was held in Ottawa this past weekend. The conference brought together health-care practitioners, policy-makers, and academics from across the country and around the globe. The speakers shared success stories about pharmacare programs in other countries. While we will need to find a pharmacare program that best suits the needs of the people of Canada, it is clear from the presentations that very successful pharmacare models are operating in other countries and Canada has fallen behind. It is very clear that the time and need for pharmacare in Canada has come.

The biggest challenge to pharmacare now is the current federal government. With Stephen Harper and his Conservatives walking away from the 2014 Health Accord and abdicating their responsibilities for health care, Canada's health-care system will stagnate. We need federal leadership now to expand public health care and ensure everyone can access all forms of medically necessary care.

Photo: e-MagineArt.com/Flickr

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