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Public funding of essential drugs could save billions

Canada lacks a national prescription drug coverage program
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A recent study found that the universal public coverage of 117 essential medicines could save at least $4.27 billion per year for patients and private drug sponsors, while costing the government $1.23 billion per year.

The paper, published in the Canadian Medical Association Journal (CMAJ), compiled a preliminary essential medicines list that accounts for 44 per cent of all prescriptions and 30 per cent of total prescription drug expenditures in Canada in 2015.

“We show that adding universal public coverage of essential medicines to the existing system of drug coverage in Canada is a significant and feasible step in the right direction,” said Dr. Steve Morgan, one of the co-authors of the paper and a Professor in the School of Population and Public Health at the University of British Columbia, in a press release.

The list was adapted from the nineteenth World Health Organization Model List of Essential Medicines specifically for the prescriptions in Canada, and has been rigorously peer-reviewed by researchers and clinicians.

While Canada boasts a universal public healthcare system, it is by no means perfect. According to the Commonwealth Fund, Canada’s healthcare system ranks thirtieth in the world and is the second worst in terms of after-hours access to healthcare.

Moreover, Canada is one of the only developed countries with a universal public healthcare that does not cover prescription drugs. The rising costs of pharmaceuticals is a convoluted system and critical challenge that greatly influences the quality of life for Canadians.

“The World Health Organization says these essential medicines should be available to everyone who needs them,” said Dr. Nav Persaud, a co-author of the paper and an Associate Scientist at the Li Ka Shing Institute of Knowledge.

Persaud is also an Assistant Professor in the Department of Family and Community Medicine at the University of Toronto and a staff physician in the Department of Family and Community Medicine at St. Michael’s Hospital.

In an interview with The Globe and Mail, he added, “I think most people in Canada agree that someone shouldn’t go bankrupt because of a health need.”

Although provinces cover drug prescriptions for certain demographics, such as seniors, approximately one in 10 people cannot afford prescribed medication in Canada.

A study by the Angus Reid Institude found that over “one in five Canadians report that in the previous 12 months, they or someone in their household has skipped doses, split pills, or not filled their prescription to save money on medication.”

When patients skip prescriptions, they allow their health to deteriorate further which places a heavier burden on the current healthcare system. Among the essential prescription drugs not covered are those treating “rheumatoid arthritis, HIV” and “some heart conditions.”

Currently, one in eight Canadians between the ages of 55 and 64 do not take their prescribed medication due to high costs. In other words, the baby boomer generation is becoming one of the most vulnerable demographics in the face of rising drug costs.

Due to the lack of affordable heart medication, a 57-year-old person, for example, could suffer further heart disease complications, placing a strain on our already exhausted health care system should they take time off work or drop out of the workforce entirely.

This begs the question as to why Canada continues to provide universal public healthcare without prescription coverage.

A CBC investigation has revealed that Canadians pay the second highest prices for drugs worldwide. The research also included a pharmaceutical price comparison with other countries. The average price of generic drugs on the essential drugs list was 47 per cent lower for those in the US Veterans Affairs program, 60 per cent lower in Sweden, and 84 per cent lower in New Zealand than in Canada.

The researchers argued that the patchwork coverage of private insurance was ineffective at negotiating and achieving cheaper net rebate prices. This raises the prescription costs of Canadians who are either inadequately insured or not insured at all. Morgan and Persaud’s paper shows how government bulk purchases can decrease the overall costs of general and name-brand prescriptions for Canadians.

A 2015 poll conducted by the Angus Reid Institute, a non-partisan, not-for-profit polling organization, found that 91 per cent of 1,556 Canadians supported a national pharmacare program.

Mindset Foundation in partnership with the Angus Reid Institute, reported that 29 per cent of British Columbians are unable to access medicine due to affordability.

Despite growing support for national pharmacare, 51 per cent of those surveyed expressed concerns regarding drug abuse.

While the research demonstrates that single-payer coverage would be an economical and effective government reform, there are a number of institutional barriers and logistical complications facing a change of this magnitude.

In a CMAJ podcast, Morgan acknowledged that one challenge would be “the delineation of a truly national and evidence based formulary that could include potentially thousands of products on it. For every one of those products you would need a pricing and supply contract to be ironed out with the manufacturers.”

Morgan emphasized that the coverage of 117 essentials is not the end goal of universal public pharmacare in Canada. Rather, it is more of a step to understanding whether this is a viable and sustainable option.

He ended the CMAJ podcast by saying, “It’s sufficiently pragmatic… This incremental step may actually be something that could be on the table.”