Ask the Pharmacist

Q) I have been hearing a lot about Pharmacare. What is it exactly and would it be a good thing for Canada?

A) Pharmacare is the word experts are using to describe Canada’s version of a universal drug plan. In other words, it would be a piece of legislation that would make prescription drugs roughly the equivalent to physician and hospital visits, something that would be covered by our taxes (or at least the vast majority of their cost) and therefore accessible to all.

This was the original intent from Justice Hall’s recommendations back in 1964 when the framework for Medicare was first laid out. However, for assorted reasons it was not adopted then or since and this is despite the fact that every major royal commission on health (i.e. the Romanow report of 2002) has advocated for it.

This week we’ll describe the principals that most people feel should be the foundation of any Pharmacare program and then we’ll spend the next two weeks looking at both its pros and cons to try and give you a better understanding of whether this concept is, in fact, worth pursuing. Finally, we will consider the differing ways our 3 main political parties are approaching this issue.

Why look at it now? Well because it’s going to be an election issue, admittedly amongst many others, in particular if either the Liberals or the NDP drive the discussion (the PC’s, at least at this point in time, have not released a statement regarding their position on Pharmacare but it does not appear to be a priority for them).

The important thing to remember about Pharmacare is that it is a thing that comes in many different flavours and we’ll need to look at the many different systems operating around the world and pick and choose what to borrow as well as what to avoid as we come up with a uniquely Canadian strategy (this of course assumes we do go forward with this legislation).

While there are lots of important decisions to make in deciding upon a solution (such as should we have co-pays, which is a term referring to the amount a person would pay out of their own pocket when filling a prescription which could be a flat rate (i.e. $2) or a percentage of the total cost). 

The essential one will be whether we select a fill-in-the-gap type option where the government will step in and only cover those who currently don’t have a drug plan or whether we do a complete redo.  In this option, all of the separate provincial and employer paid drug plans are scrapped in favour of one single drug plan for all Canadians, paid for by the government (which is really us), which leverages (hopefully) its massive buying power to negotiate lower prices.

Both are doable and both have substantial advantages and trade-offs. Regardless of the strategy chosen, most advocates believe that Pharmacare should embrace the following 4 principals.

The first one is universality. This means that every Canadian citizen, regardless of age or location within Canada, should be covered for prescription drugs. It also means that we are all covered equally so that there are not better or worse plans depending on where you live or your income levels.

It also means that instead of being dependent on holding onto your job in order to maintain your drug coverage, which can be tenuous for many, maintaining your benefits under Pharmacare would only depend upon you maintaining your citizenship. This should be a massive relief for those receiving thousands of dollars worth of drugs every year as they battle through the challenges of such diseases as diabetes, the auto-immune disorders or, of course, cancer.

Pharmacare should also embrace the principal of accessibility. This means that even if we do decide to include a co-pay to prescription drugs, which can help us afford it and may make us more conscientious about using it, the amount should not be so high as to prevent those with lower incomes from being able to afford their medications.

Pharmacare should also embrace the philosophy of portability. The coverage should stay with you, regardless of where you move to. As well, it should move transfer to a new province instantly so that there is no gap in coverage as you get settled into your new life.

Lastly, Pharmacare should be comprehensive. The formulary (this is the name for a large group of different drugs covered by a drug plan) should be as extensive as we can afford and it should be based on selecting drugs that are scientifically proven to be safe, effective and provide value for their cost. This does not mean it should cover every drug. That would be unaffordable and unnecessary.

There are comparable drugs that are equally effective and safe in treating conditions but whose price can differ by as much as 30%. Those sorts of cost differences extrapolated over millions of citizens could equal tens of millions of mostly wasted dollars. We will also need to decide if we should cover the costs of drugs that treat real conditions but ones that if left untreated don’t significantly impact our mortality or morbidity. This of course would be drugs such as Viagra or the vitamin A acid creams that can diminish facial wrinkles.

There is a lot here to think about, but there is one principal that I think Canadians of all political stripes can agree upon. That is, we need to end the era where some of our neighbours cannot afford their prescription drugs and as such allow their blood sugars or cholesterol to run amok thereby increasing the chances that they live shorter and sicker lives than the rest of us.