Ask the Pharmacist

Q) Now that I know just what Pharmacare is (having read last week’s wonderful albeit long delayed column) is it even a good idea?

A)  That is a question experts, not only in Canada, but around the world have been debating for years. Your own personal answer to this question may be one of the factors that helps you decide who to vote for nationally this fall as all three parties may well have very different answers to this question.

As well, as mentioned last week, your own personal response to this might well depend on what type of system is chosen for Canada, if we do indeed decide it is time this country embraced Pharmacare as a necessity.

Some will only embrace the notion of spending tax dollars on helping those who have no drug coverage presently whereas other think we will only reign in our astronomically high drug prices if we take advantage of a single payer (the government) covering everyone and using the leverage to negotiate more aggressively on drug prices.

Regardless of the methodology, proponents would argue that Pharmacare will save lives over our current patchwork system (currently people are covered either through the government, an employer or pay out of their own pocket to the extent that Canada has over 100 different public plans and over 100,000 private ones). Right now, 1 in 10 Canadians cannot afford to fill their prescriptions and Canadians are 3 to 5 times more likely to skip taking their drugs than residents from comparable countries with universal drug plans.

The class of drugs that is most commonly skipped would be those for mental health, a scary proposition as we combat the opioid crisis and a critical shortage of psychiatrists. Further to this point, a 2012 study conducted by St. Michael’s estimated that inequities in drug coverage for working-age diabetics accounted for 5,000 deaths between 2002 & 2008. This was for Ontario only. These stats affect all ages & genders but tend to hit the youngest the most due to their generally lower income levels & lack of insurance benefits.

Those in favour of Pharmacare would also argue that it is also the right thing to do. The World Health Organization considers access to medications to be a basic human right. We are the only high-income country with a universal health system that does not also provide prescription drug coverage. Ten to 20 percent of Canadians do not have drug plans and an equally high number do but have such high co-pays (the amount of money a person has to pay above what their insurance pays for the prescription) or low limits (the dollar value after which the insurance company will not pay any more money until the following calendar year) that they face significant financial consequences in trying to pay for their drugs.

A study by a Canadian medical journal estimated that 730,000 Canadians have cut back on the food they buy & another 239,0000 have walked away from other health care costs (such as dental care) in order to save the money necessary for their medications.

While Pharmacare will undoubtedly be expensive, many insist that in the long run it will save billions. It shouldn’t be hard to do better than we are currently. Right now, we spend more on prescription drugs per person than any other country in the world save one (you’ll never guess who??? I’ll give you a hint. It’s the one building the next great wall on its southern border).

We spend 50% more per person on drugs than countries such as the United Kingdom & New Zealand and they do have universal drug plans that are incredibly affordable (New Zealander’s pay essentially $100 or less a year). We do this without getting better health outcomes for our extra dollars. We don’t live longer or healthier than they do.

The parliamentary budget officer estimated that, if the government negotiated and bought all the drugs for all Canadians (the so-called single payer system), we could save $4.2 billion annually just from our increased negotiating power.  As well, by providing affordable prescription drugs, we should be able to keep more people out of our doctor’s offices, emergency rooms as well as reduce our hospital admissions.

A study by the same Canadian medical journal estimated unaffordable prescription drugs accounted for an additional 303,000 doctor’s visits (the national average in 2014-15 was that each visit costs tax payers $45.61), 93,000 seeking care at a local emergency department and 26,000 more in-patients in our hospitals. These are expensive ways to treat patients and lead to longer wait times for everybody.

Another reason to embrace Pharmacare is that the framework is, somewhat, already in place. We have recently created a Pan-Canadian Pharmaceutical Alliance which has aggressively negotiated down the prices of a select group of drugs for our various government drug plans to the tune of spending $3 billion less over 5 years on generic drugs. Their negotiations are not reducing how many pills they are buying or eliminating people from their drug coverage. They are simply paying less money for the exact same drugs.

Lastly, a national Pharmacare plan will be good for Canadian businesses, especially small ones. The number of prescription drugs that cost over $10,000 per year has grown more than 10 fold in the past decade. That trend is going to continue.

Drug plans are becoming unaffordable for many small businesses causing them to risk becoming uncompetitive with their foreign rivals or going bankrupt if they maintain them. This will, and has, led some businesses to eliminate drug coverage plans to their employees leaving them to fend for themselves.  This could, potentially, be a real boost to the economy and help lure good jobs to our country as it will save multinationals large amounts of money they would need to spend in the U.S. if they were to set up shop there.

Now, having said all that, I’ll tell you next week why some think Pharmacare is a terrible idea.