Why drug plans are stagnating in Canada, even though research suggests billions in savings

While the federal Liberals pledged to move toward national pharmacare in a recent deal with the NDP, health care advocates warn those efforts are moving too slowly, putting people’s health endangered and weighing on the Canadian hospital system.

The government recently announced a “supply and confidence” deal that could see the Liberals stay in power until 2025 in exchange for action on several NDP priorities, including dental care and health insurance programs. medications.

But there is no indication that access to drugs will be a major objective in the latest federal budget due Thursday.

The Liberals plan to pass Canadian pharmacare legislation by the end of 2023, then task the National Medicines Agency with developing a national essential medicines formulary and procurement plan basically by the end of their agreement with the NDP.

It’s “worrying” that such an open timeline means the creation of a national pharmacare program is unlikely to happen until the next election cycle, said Dr. Health Justice Canada and staff physician at St. Michael’s Hospital in Toronto.

“Several reports have detailed how including the drugs in our publicly funded system would improve access, improve health, reduce the need for hospitalizations, emergency room visits and also save billions of dollars to both through direct savings, lower prices and the need for health care,” he said.

“But far more important than that money saved would be improved health and averted death.”

Research suggests billions in annual savings

In 2019, an in-depth report on pharmacare from the Federal Advisory Council on National Pharmacare Implementation, led by Dr. Eric Hoskins, highlighted just how much people’s lives can suffer. if they skip necessary prescription drugs, and noted that a pan-Canadian program could potentially result in system-wide savings of nearly $5 billion per year.

Other research by a team from the University of British Columbia and the University of Toronto suggests these savings could be even larger, at more than $7 billion a year.

“While many Canadians have some form of coverage, Canada relies on a confusing patchwork of over 100 public drug plans and over 100,000 private plans – with a variety of premiums, quotes -shares, deductibles and annual limits,” Hoskins wrote in his report.

“For a family or a single patient with a complex disease, these costs can be a significant barrier.”

About 20% of Canadians have inadequate or no drug coverage and must pay out of pocket, he continued.

The Liberals made universal pharmacare a central part of their platform in 2019, but in the 2021 campaign it was barely mentioned by the party.

During the election campaign that year, NDP Leader Jagmeet Singh claimed that a federal pharmacare program that would allow Canadians to access drugs with their health cards could cost around $10 billion. dollars, while saving the provinces about $4 billion.

Singh went on to slam Justin Trudeau’s government after the next budget left out spending to expand the program, with the NDP leader saying the Liberals chose to please ‘big pharma’ rather than working families .

NDP health critic Don Davies recently told The Canadian Press that he expects the Liberal government to keep its renewed promise to deliver national pharmacare, but maybe not all of a sudden.

“You start, then you build on it,” Davies said in an interview last month.

Persaud, however, said faster action was needed to make up for previous “broken” promises.

“It’s pretty clear that your health card should work in pharmacies the way it works in the emergency room, or when you see your family doctor, or before you have heart surgery,” he said.

“People have to make very tough decisions about rationing their insulin use or making decisions about paying rent or buying their medicine. And those are decisions no one should have to make.”

“Near death experience” without insulin

Ted, a Burnaby, B.C. resident with diabetes, found himself faced with this kind of life-threatening decision during the pandemic.

At the end of 2020, the 42-year-old lost his job. As the months passed, his family of five’s finances got tighter – and when his provincial access to pharmacare was reset in early January this year, Ted realized he had to do facing a deductible of at least $1,500 before his insulin is covered.

The choice was clear: put food on the table and pay the rent, or invest that money in medicine that would help keep him healthy and alive.

Ted decided to skip his insulin.

The father-of-three – whose identity CBC News is shielding due to diabetes stigma and to avoid further trauma to his family – felt fine for the first two months.

But in March, he began to experience shortness of breath, chest pain, fatigue and nausea. One night that month, he vomited at least eight times.

“Come in the morning, my family found me on the sofa half-conscious, barely catching my breath,” he recalled.

Ted’s oldest daughter called 911 and her father was rushed to a Vancouver-area hospital where she was diagnosed with diabetic ketoacidosis – a life-threatening condition that develops when your body doesn’t have enough insulin to allow blood sugar to enter your cells for energy. He ended up spending time in the emergency room and several days in intensive care.

“It was kind of a near-death experience,” he said.

“Constant battle” to help patients access medicines

Ted is now back on insulin, thanks to the help of Dr. Tom Elliott, the medical director of the BC Diabetes advocacy group, an organization that fights for more support for diabetes patients in British Columbia while supporting the universal pharmacare.

“I just want to be able to get my patients the medications they need, so it’s a constant battle every day,” Elliott said.

Patients often struggle to get medications and supplies to manage their diabetes, he said, noting that this is a situation that can sometimes lead to people dying in just days while putting pressure on finance on hospitals.

In Ted’s case, BC Diabetes estimates his brief hospital stay likely cost about $25,000, many times his deductible.

“You can’t expect a family of five to pay that much for lifesaving medicine,” Ted said.

“The government must take serious steps to bring about change.”

“If you have a medical condition that requires lifelong therapy, it should be provided by the state,” echoed Elliott.

But while advocates argue a national pharmacare program could provide broad benefits, other organizations have pushed for a slightly different approach.

Industry groups support pan-Canadian approach

A “pan-Canadian approach to drug coverage” would be more feasible than a national framework, the Canadian Pharmacists Association said in a 2017 article, which claimed it could leverage provincial insurance infrastructure. /territorial and private sector.

Innovative Medicines Canada (IMC), the association representing the country’s research-based pharmaceutical industry, announced in March that it welcomed the federal government’s renewed commitment to improving access to medicines, but it also supports a pan-Canadian approach.

In a statement, IMC said a pharmacare program should ensure a strong and competitive national pharmaceutical industry and “build on the strengths of our current dual market system,” according to the IMC president. Pamela Fralick.

Persaud said industry resistance to a universal national pharmacare program may be one reason efforts continue to stall to create one.

“I think one of the biggest problems with pharmacare is that it would save billions of dollars and it would mean less revenue for pharmaceutical companies and private insurance companies,” said he declared.

“And they’re lobbying against those changes.”