The issue of a national pharmacare program is more nuanced than it may appear at first glance, said Joe Farago during a presentation at the 2018 Halifax Benefits Summit on Sept. 20.
“Canadians are starting to change their views,” said Innovative Medicines Canada’s executive director, private payers and investment, during the conference. Farago pointed to a national poll of health-care providers, managers and the public, which found just 29 per cent of respondents prefer a single, national pharmacare plan. However, 32 per cent said they feel the best approach for accessible prescription medicine is for the federal government to fill in the gaps for those who aren’t currently covered.
The existing scope and speed of coverage may be contributing to these shifting preferences, noted Farago. Some 22.5 million Canadians and their families are enrolled in a private drug plan. These plans approve drugs, on average, three-times faster than public drug plans, and cover a much broader range of drugs, he said. “What is national pharmacare trying to fix?”
At the heart of the issue are concerns about individuals and families with no coverage, said Farago. A 2017 study from the Conference Board of Canada found 36.2 million Canadians had prescription drug coverage of some kind, and only 660,000 (or 1.8 per cent) had none.
However, the drive for a national pharmacare program goes beyond the number of people covered, said Farago. “The federal government implication is that private drug plans are wasteful.”
The study found that total private drug claims grew by 4.7 per cent between 2012 and 2016, with the number of claimants (2.1 per cent) and cost per claimant (2.6 per cent) growing at a similar pace. The cost per claimant was driven both by growth in number of claims per claimant (1.4 per cent) and in cost per claim (1.2 per cent).
“Seventy-five per cent of the growth in the private drug plan market is due to utilization,” said Farago.
Future growth, he added, will be largely driven by products currently on the market. “Plan sponsors need to take a close analysis of their own plan cost drivers, including other factors such as chronic disease.”
Read more coverage from the 2018 Halifax Benefits Summit