Unfinished business: Time for a national Pharmacare system

More than 15,000 people in Kawartha Lakes do not have adequate prescription drug coverage. Far too many of our fellow citizens with a needed prescription can’t afford to get the medicine, or they ration the prescription in ill-advised ways. Not filling a prescription (or rationing incorrectly) due to the price of medications is something experts call “cost-related non-adherence (CRNA).” That’s a fancy way of describing people who can’t afford to take their drugs properly, if it at all. And the number of people who are forced to do this is staggering, because of the lack of a national Pharmacare system.

A 2015 survey found that “24 per cent of Ontarians reported that they or a member of their household did not take their medications as prescribed, or missed medications, due to cost.” Given that, according to the CMAJO, “drugs for mental health conditions were the most commonly reported drug class for cost-related non-adherence.” It’s clear that prescription drug cost is a major problem, not just nationally, but locally.

It’s a sad reality that pharmacists are all too familiar with. Cathy Puffer is a local pharmacist and owner of Remedy’s Rx in downtown Lindsay.

“I have had many patients who take their medication on a sporadic or inconsistent basis to try and make them last longer. There are obvious detrimental health effects to playing with dosages. Patients routinely ration their medication to make it last longer. Patients who can’t afford their medication often end up with more frequent emergency room visits and hospital admissions which increase our overall health care costs,” says Puffer.

Other frontline hospital workers also have to deal with the effects of people unable to take their medication properly because of cost.

Linda Silas, president of the Canadian Federation of Nurses Unions (CFNU) represents nearly 200,000 nurses in Canada. She told The Lindsay Advocate nurses have been talking about the need for Pharmacare for decades, because they witness that need every day as they care for their patients.

“We watch with frustration as patients struggle to access medications they need to stay healthy, in some cases ending up in hospital repeatedly as result of not filling prescriptions, or not taking their medications as prescribed because of the cost. Sadly, in some cases, they even lose their lives.”

Preventable Deaths

Recent research by Silas’ organization points to 550-670 preventable deaths per year amongst Canadians aged 55-64, and up to 70,000 older Canadians (55+), who suffer avoidable deterioration in their health status every year due to a lack of affordability of medicines.

What would prevent our neighbours in Kawartha Lakes and elsewhere from becoming one of those sobering statistics is a national, single-payer Pharmacare system. And while some people today might confuse the idea of Pharmacare with the position of one or more political parties, the fact is that the idea has been around for as long as the health care system that we enjoy today. We have been talking about it since the Royal Commission on Health Services in 1964 and four major investigations since. All these investigations have concluded that national Pharmacare is needed.

As Canadians we often feel pride in our universal health care but the fact is that we have dropped the ball on one of the most critical components of modern healthcare: medicine. The World Health Organization has declared that “all nations should ensure universal access to necessary medicine.” Every developed country with a universal health care system provides universal coverage of prescription drugs — except Canada.

Because we didn’t finish the job, what arose was a patchwork of provincial and private plans that covers some Pharmacare for some people. In Ontario, there is coverage for most drugs for people under 18, those in long-term care or hospital, people on Ontario Works or Ontario Disability Support Program, and those people 65 or over. The Trillium Drug Benefit is an income-tested support for people whose drug costs exceed a portion of their income. Certain medications for catastrophic conditions are also covered for all citizens. That still leaves 24 per cent of Ontarians 64 and under without a drug plan.

Worse still, there are over 100 different plans across the country that provide some sort of Pharmacare. This leads to a very inefficient system, both in terms of administrative costs and the ability to negotiate drug prices with pharmaceutical companies. A 2015 paper entitled Pharmacare 2020: The Future of Drug Coverage in Canada, written by six academics for UBC’s Pharmaceutical Policy Research Collaboration, outlined the fiscal costs of our current patchwork system. It concluded that duplication of services by the mishmash of plans leads to exorbitant administration costs and notes that “in terms of drug prices, Canada’s multi-payer system is among the most expensive systems in the world, because it diminishes our purchasing power.”

“The prices of generic drugs in Canada are nearly double (79 per cent higher than) the median of prices found in other OECD countries and more than four times (445 per cent) higher than the best available prices. Similarly, the prices of brand-name drugs in Canada are 30 per cent higher than in comparable countries like the United Kingdom. Comparable health care systems around the world achieve lower prices by using the purchasing power of a single payer for pharmaceuticals. Manufacturers who price competitively get the reward of their drugs being covered for 100 per cent of the population. The savings can be remarkable.”

The authors use one easily understood example for the commonly prescribed Lipitor: the (2015) cost of a year’s supply of Lipitor in Canada is $811; the cost of a year’s supply in New Zealand is $15. Long story short: Canada pays some of the highest drugs per capita in the world and yet still 20 per cent of the population isn’t covered.

One of the first things the PC government led by Premier Doug Ford did when they took office was cancel — or modify, depending on your point of view — OHIP+, which the Liberal government had introduced to basically extend Pharmacare in Ontario to those 25 and under. In March of 2019 the federal Advisory Council on the Implementation of National Pharmacare (led by former Ontario Minister of Health Dr. Eric Hoskins) released an interim report advocating a list of drugs that should be available to every Canadian regardless of their ability to pay — a move that the Globe & Mail described as ‘tip-toeing’ towards Pharmacare.

One of the authors of the Pharmacare 2020 paper, Marc-André Gagnon, PhD, from Carleton University’s School of Public Policy and Administration, told The Lindsay Advocate why we, regardless of one’s current personal coverage, should be advocating for a national, single-payer pharmacare.

“The cost increase for private plans is simply unsustainable and most private plans are now introducing measures to better contain costs, but they do not have the tools necessary to be efficient at containing costs. Many people with private plans are now anxious about what will become (of) their private plan.”

Gagnon anticipates resistance to Pharmacare from those who believe that private plans are better because, contrary to public plans, they expect to cover drugs that do not provide value for money. He considers this to be harmful in that it provides incentives for drug companies to produce insignificant drugs at high prices.

A universal public plan, according to Gagnon, would cover “all efficient drugs that provide value for money at a fraction of the cost we pay for them right now in our fragmented system.” Employers could still provide additional coverage for what he calls wasteful drugs while still benefiting from a reduced cost for the bulk of prescribed drugs.

For people who already have public coverage, “national Pharmacare would simply mean they would get better coverage at a lower cost due to the greater bargaining capacity of a national system,” adds Gagnon.

The trend in drug manufacturing sees expensive niche drugs being developed as opposed to the ‘blockbuster drugs’ intended for a mass market. This means that drugs are becoming more expensive and this means higher costs with fewer benefits for those of us lucky to be on an employer plan. With the rise of the gig economy, fewer employers are actually offering those plans, as noted by the think-tank C.D. Howe Institute: “the percentage of Canadian employers offering retirement health benefits to new employees has fallen from 62 per cent in 2002 to 49 per cent in 2011.”

There is no doubt that number has fallen even more since, making local employers like Jason Hore, owner of St. Dave’s Diner in Lindsay, a growing rarity. The costs for him, depending on the number of employees at any given time, ranges from 12,000 to $20,000 a year. Every economic model of our current system sees those costs rising at a rate far above inflation. And let’s not forget, healthy people make better employees.

“Pharmacare would be a “preventable measure that definitely would help,” Hore says, meaning such things as employee absenteeism and overall employee wellness.

Hore says he would think a national Pharmacare plan “would be a given” in a country like Canada.

National, Single-Payer System

Our current system just isn’t working.

“The evidence (for universal Pharmacare) is overwhelming (and) is the best option, both economically and for ensuring patient access,” says Silas.

“Only a universal Pharmacare program will allow us to pool our buying power to negotiate lower drug prices and save in the range of $4 to $11 billion every year. And only a universal Pharmacare program can transform our current patchwork system into seamless coverage for everyone.”

A coming election means that we will undoubtedly hear about Pharmacare for a month or two. However this is one issue that shouldn’t be subsumed with partisan bickering.

This issue affects literally every Canadian and all available data points to one conclusion: it is time a national, single-payer system.