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The fight for a comprehensive pharmacare program

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Image: Linda Silas

Nurses have been standing for pharmacare for decades, and campaigns to raise the profile of pharmacare among politicians have been undertaken by the CFNU nearly every year since 2004.

Why are nurses so concerned about this issue? Because they are on the frontlines of care. Nurses see what not being able to afford prescription drugs can mean in terms of human and financial costs for our healthcare system. In a damning report titled Body Count, internationally renowned physician and pharmaco-epidemiologist Dr. Ruth Lopert quantified the conservative cost in death and avoidable health status deterioration due to the prohibitive cost of prescription medicine. Tens of thousands of Canadians are impacted, according to the report, and need action on pharmacare now.

The federal government has made a commitment to a national pharmacare program and provincial premiers are discussing how their provinces would implement pharmacare; these are great steps forward. However, the industry which has developed around private pharmacare is lobbying to water down proposals. This is when our efforts matter.

The Activist Toolkit interviewed Linda Silas, president of the Canadian Federation of Nurses, to learn more about how we got this far, and what needs to be done now to ensure that the national pharmacare plan is a comprehensive policy.

Activist Toolkit (AT): Why wasn't pharmacare included in Medicare as it was originally proposed, and how did the current pharmacare system develop?

Linda Silas (LS): A pharmacare plan was always meant to be part of phase two of the original Medicare plan for Canada. The fact that it wasn't in the initial phase was in large part because prescription medications comprised a much smaller component of healthcare back in the 1960s. In the subsequent decades, population health needs have shifted with the greater prevalence of chronic diseases and the emergence of new pharmaceutical technology to improve health and relieve suffering.

Currently, prescription medications dispensed in hospitals count as falling within the 'basket of necessary health care services' and are thus covered under medicare systems. But, this coverage does not extend outside of hospital.

In the absence of a public, universal pharmacare plan, the private sector filled the gap to provide coverage through employers for prescription medications. Prescription coverage is usually covered within broader extended health benefit plans. Federal, provincial and territorial governments have also extended coverage to select groups, in particular seniors, the unemployed, veterans etc. But this coverage is at best a patchwork and leaves many people in Canada who are in need of prescriptions, without coverage.

AT: What are some of the most difficult things you have heard about the consequences of not having a national pharmacare program, both for healthcare providers and for patients?

LS: Every day, nurses experience the tragedies of patients returning to hospital in more aggravated health crises because they couldn't take their medications as prescribed because of cost. Frontline staff raise these stories at CFNU conventions regularly when pharmacare is discussed at plenaries.

We continue to collect accounts from health care providers, patients and their families. The CLC's A Plan for Everyone website is collecting personal accounts and sending them to MPs and provincial politicians. We need politicians to know why this issue matters to people across Canada.

If your want to read some accounts here are a few sources:

  • The proceedings of the Health Committee study about pharmacare from 2016-2018, in particular of people returning to hospital in diabetic shock because they couldn't afford their insulin.
  • CBC Fifth Estate also did a profile on the pharmacare issue, which included stories of Canadians families suffering.
  • Faces of Pharmacare, one of many independent initiatives sharing stories about the need for comprehensive pharmacare

AT: What are some things we should read, or listen to, in order to be better informed about why we need a national pharmacare plan?

LS: Aside from the tools above, it is good to hear from the broad spectrum of allies who support a single payer pharmacare system, like the BC Chamber of Commerce. The BC Chamber of Commerce states that because Quebec chose a system which says all employees must have drug coverage which can be purchased through the current hodge podge of drug coverage providers, private employers and households in Quebec now spend $200 per capita more on pharmaceuticals than employers and households in the rest of Canada.

A report entitled Pharmacare Now: Prescription Drug Coverage for all Canadians was published by the Standing Committee on Health earlier this year and takes into the account information and submissions from across Canada. It is a very comprehensive analysis of the issue and of the efforts made to date to address this issue.

The Canadian Federation of Nurse Unions has published the following reports which may be useful for allies: the Body Count report, which details the human cost of not having a national pharmacare program and the Down the Drain report which details the financial cost of not having a national pharmacare program. We have also developed a roadmap to develop the national pharmacare program from the perspective of CFNU and we support the work of our allies who developed the Pharmacare 2020 report.

AT: What have CFNU and its affiliates and allies done to move this issue forward at the federal, provincial, and local levels?

LS: CFNU's predecessor first adopted a resolution in favour of a national pharmacare program back in 1991. Campaigns to raise the profile of pharmacare among politicians and the public have been undertaken by CFNU nearly every year since 2004.

CFNU's lobbying efforts commenced with our attendance at the 2004 health accord negotiations between Canada's First Ministers. Canada's nurses were committed to elevating the profile of prescripton drug coverage at this historic conference and celebrated the moderate success achieved.

Since then, CFNU has held multiple policy briefings with Parliamentarians, health ministers, premiers on Parliament Hill and at their annual summits on the topic of pharmacare. Our policy briefings have become a regular feature of the annual political calendar attracting considerable attendance. At every event, CFNU tackles the topic of pharmacare from a different angle, whether it be financing, human cost, fiscal waste of the current system, and the challenges of federalism.

These efforts have ramped up considerably since the 2014 release of the CFNU report A Roadmap to a Rational Pharmacare Policy for Canada.

During the 2015 election, CFNU ran a multi-faceted 3rd Party campaign to promote the profile of pharmacare among nurse members, the public and politicians alike. We helped achieve a historic first with two of the four main political parties endorsing pharmacare in their platforms.

Since the 2015 election, CFNU has worked with health spokespeople from each of the political parties to bring the issue to parliament. Canada's nurses played an instrumental role in compelling the Standing Committee on Health to undertake a near-two year long study of pharmacare. This historic study involved over 130 testimonies and submissions from experts and stakeholders from across Canada. The result was the report Pharmacare Now which received mutli-party support and which unequivocally recommended the implementation of a universal, single-payer pharmacare plan for Cnaada.

In 2018, CFNU attended both the Liberal and NDP federal party conventions and worked with health advocates within the party to encourage members to adopt policy resolutions in favour of the implementation of universal, single-payer pharmacare. In fact, the pharmacare resolution at the Liberal convention was voted number one policy priority by Liberal rank-and-file members.

AT: The federal government wants to work with premiers on fleshing out the national pharmacare plan. The premiers are quite ideologically diverse -- from Doug Ford to John Horgan and Rachel Notley. As they flesh out the plan, what do we need to make sure is included?

LS: In order to fully realize the promise of national pharmacare, CFNU believes the system must be built right. It's not a question of any kind of pharmacare programme, it's a questions of the right kind of pharmacare programme.

The CFNU has outlined four principles that much guide the successful implementation of pharmacare for Canada. They can be found here, and they are: public administration, universality, singlepayer and national formulary. These principles provide the foundations for the establishment of an effective system.

Activists ought also to familiarize themselves with the Pharmacare 2020 document to understand a more fully fleshed out proposal for the implementation of pharmacare. Another valuable reference tool is the lengthier, Roadmap to a Rational Pharmacare Policy document.

AT: What are some ways we can stand with nurses to demand their vision of a national pharmacare plan?

LS: The most important work to be done of the coming year before the 2019 is to raise the profile of pharmacare amongst political candidates. The campaign for national pharmacare has never enjoyed as much momentum as it does now. We are at a crucial juncture, with three out of the four main federal political parties supporting pharmacare. Activists need to help translate this momentum into action by framing pharmacare as a winning issue at the constituency level. This will help make it into a political priority for Liberals, New Democrats and Greens and will mollify opposition in Conservative camps.

To achieve this, activists should look for opportunities to showcase the struggles and tragedies that people in Canada face without access to prescription medications. These stories are powerful (some of which are contained in the Body Count report linked above) and they serve to compel politicians into action, to win over public support and to attract media attention.

Pharmacare is also an issue that can be used to organize and mobilize folks who currently fall through the cracks or who worry about the inadequacy of their workplace plans.

Image: Linda Silas

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