Canada is the only developed country with a universal healthcare system that does not provide universal coverage of prescription drugs. With a new national ‘pharmacare’ program being proposed to remedy this situation, Pamela Fralick of Innovative Medicines Canada outlines the strengths and weaknesses of the proposal on the table and argues for a fix of Canada’s existing public-private model rather than the disruption of creating an entirely new system.
No model of national pharmacare should result in a lower level of coverage than what they have now
The Canadian government has an opportunity to shape the future of pharmacare, a national program that Canada clearly needs.
In March, the federal government took a small step forward with the release of the interim report of the Advisory Council on the Implementation of National Pharmacare.
Like the Advisory Council, Innovative Medicines Canada supports comprehensive and universal access to drugs for all Canadians – regardless of age, income or postal code. And we agree the first priority for national pharmacare should be to close existing coverage gaps for the uninsured and the underinsured.
Currently, provinces, territories and private insurers each have their own formularies that identify which drugs will be covered, and there are significant variations across these formularies. The interim report proposes that the federal government, in partnership with provinces, territories and others, begin the development of a comprehensive, evidence-based national formulary that would serve as the baseline for harmonizing coverage across Canada.
As we wait for more details to be announced, Canadians should expect the proposed national formulary to mirror the highest standards of coverage among provinces and private payers, so that patients are still able to access the medicines they depend on today.
It will also be important to learn more about how this policy proposal will impact Canadians who have comprehensive existing drug plans. This includes the 23 million Canadians with employer-sponsored drug plan coverage. No model of national pharmacare should result in a lower level of coverage than what they have now.
We agree with the Advisory Council that Canada urgently needs to provide more equitable and timely access to medicines for patients with rare diseases. They are often among the most vulnerable, since there are typically limited treatments available and they are less likely to be covered under most existing public and private drug benefit plans. We would welcome immediate federal-provincial-territorial cooperation and engagement with our industry to address this issue – we have approaches and solutions from our global experiences that could be useful in a Canadian environment.
A national pharmacare model will ultimately be judged by its ability to provide Canadians with timely access to medicines
We also support the report’s recommendation to invest in drug data and information technology systems, which have the potential to improve prescribing practices and further strengthen patients’ standard of care across Canada. Similarly, a Canadian Drug Agency – if done right – should streamline Canada’s complex drug regulatory processes and shorten the time between when a new medicine is approved for use in Canada and when it is covered by a public drug plan.
A national pharmacare model will ultimately be judged by its ability to provide Canadians with timely access to medicines. That is why the Advisory Council’s interim report must be considered within the broader context of the regulatory changes currently being proposed to the Patented Medicine Prices Review Board (PMPRB).
These proposed changes will negatively impact how quickly new drugs become available to Canadians. A recent EY study clearly demonstrates that market conditions matter when it comes to decisions on whether and when to launch new drugs in a given country. Our industry fears that the proposed PMPRB changes will delay new medicines from coming to Canada or discourage them from coming at all.
For any national pharmacare option to be successful, federal and provincial governments and all key stakeholders need to be working together. Any implementation plan should involve significant collaboration with both private insurers and federal/provincial/territorial health system managers, patient groups, clinicians, the pharmaceutical industry, and the health benefits advisors to ensure that patients receive the best standard of care and have access to necessary medicines and treatments.
Most Canadians are well served by the current system of dual public and private coverage. So, let’s recognize the value of the existing mixed public-private model built over the last 50 years, focus on fixing what is not working, and avoid the disruption of creating a new system.
It is our hope that whatever model the Canadian government ultimately puts forward reflects the value that medicines bring to individual patients and ensures timely access to a comprehensive range of medicines that Canadians need to maintain and improve their health.