OTTAWA—Canadians should have access to a universal system of prescription drug coverage to replace a patchwork of public and private systems that leave many citizens unable to afford the medicines they need.
In its final report released Wednesday, an advisory council appointed by the federal government called on Ottawa to work with the provinces to establish a single-payer, public system of prescription drug coverage.
The system would provide coverage for a national list of prescription drugs and related products to ensure all Canadians have equal access to medicines.
Under the proposed plan, out-of-pocket costs for products on that list would not exceed $5 per prescription and costs capped at $100 a year to ensure drug costs aren’t out of reach for Canadians.
In an opening statement in the report, Dr. Eric Hoskins, chair of the advisory council, bluntly laid out the crisis that he said is undermining Canada’s healthcare system.
While the country prides itself on universal health care, in reality, the rising cost of medicines means a patchwork of care.
“There are too many people in our country who die prematurely or suffer needlessly in ill health because cost is a barrier to accessing prescription drugs,” Hoskins wrote.
Today, drugs are the second-largest cost in Canadian health care, after hospitals and ahead of physician services, he said.
Currently, drugs are not covered by medicare unless they are used in hospital, leaving patients on the hook to pay. Yet the report cautions that public and private drug plans fall short of ensuring full coverage, forcing many Canadians to pay some or all of their drug bills out of pocket.
Hoskins said the current system is “near breaking point” and needs “significant, even transformational reform.”
“Given the changing nature of work and the rising use and cost of drugs, we can’t be certain how many Canadians will have adequate drug coverage in the years ahead,” Hoskins said.
He said that moving to a national pharmacare system has the potential to save billions of dollars by lowering drug prices and ensuring that Canadians have access to medicines. That avoids medical complications down the road when a manageable condition becomes a serious health problem, resulting in hospital stays and time off work.
The program would cost governments $4.1 billion in 2022, relative to what they would otherwise be spending on drugs. That annual public cost would rise to $18.1 billion in 2027, as the program expands from essential medicines to include a more “comprehensive” formulary.
The report projects that cost to government coffers would be partially offset by savings for the public.
“While initially limited, the reductions in private plan and out-of-pocket prescription drug spending would become more significant by 2027,” the report notes.
“Even when assuming that individuals and private plans continue to spend on drugs that are not on the national formulary, the (report’s models) projects that, relative to status quo projections, spending by private plans in 2027 would decrease by about $16.6 billion … and out-of-pocket spending would decrease by about $6.4 billion.”
The council recommends the creation of a new arms-length drug agency to oversee national pharmacare. This new agency would assess the clinical effectiveness of drugs, decide what drugs should be on the national list, negotiate prices with manufacturers and monitor their safe use.
It also recommends that the federal government work with provincial governments on a national strategy for expensive costs to treat rare diseases to ensure “better and more consistent” access.
Alex Boutilier is an Ottawa-based reporter covering national politics. Follow him on Twitter: @alexboutilier