Head to head: Should Canada implement a national pharmacare program?

While some say a single-payer system would mean reduced drug prices and expenditures, others argue it could have unintended consequences, particularly for private plan sponsors.

Marc-André Gagnon, associate professor at Carleton University’s school of public policy and administration:

Canada’s drug coverage is a patchwork without coherence or purpose. Some think more patches can solve the problem, but ultimately the core problem is that it’s a patchwork.

Canadians pay among the highest costs per capita for prescription drugs, along with some of the highest rates of cost related non-adherence. Rising prescription drug costs are making the system unsustainable. Major reforms are inevitable.

Read: Lessons for Canada from pharmacare systems around the world

If Canada introduced universal public coverage for cost-effective drugs, employers could still offer supplemental drug coverage. Savings from drugs covered by a public plan would reduce labour costs, allowing employers to offer additional benefits, increase wages or profits.

Why then all the fuss? First, drug benefits aren’t taxable, so private plans may lose an important advantage. Our governments incentivize employers providing private coverage with tax subsidies. However, with these subsidies, the higher your income, the more you get.

Some prefer private plans because they cover more than just cost-effective drugs. This claim is incorrect. The rising costs of specialty drugs have hit private plans hard, forcing them to protect themselves. Great-West Life Assurance Co., Manulife Financial and Sun Life Financial, representing 65 per cent of the private health benefits market, have implemented by-default programs for insured plans. While administrative-services only plans cover anything at any price, the bill is rising fast, especially considering cost transfers for specialty drugs through spousal plans.

Read: A primer on the parliamentary report on pharmacare and its impact on the benefits industry

Public drug coverage must maximize the health outcomes for all Canadians in a cost-effective way, not act as a “risk dump.” It’s time to change the paradigm and embrace the recommendations of those who have seriously looked at this issue. It’s time for universal pharmacare.

Pamela Fralick, president of Innovative Medicines Canada:

Innovative Medicines Canada agrees with the advisory council on the implementation of national pharmacare’s core principles that all Canadians should have timely access to the choice of medicines they need to maintain and improve their health, regardless of age, income or postal code.

We believe a system of universal pharmacare should build on the strengths of our current mixed system of private and public drug coverage to close the existing gaps in coverage for vulnerable Canadians — the underinsured and uninsured. Further, drugs treating rare diseases should be an important area of focus, as current private and public plans may not be meeting patients’ needs.

Read: Expert panel on pharmacare suggests harmonized national drug formulary

The proposal of a comprehensive, evidence-based national formulary could represent an important step forward in improving access to medicines, provided it mirrors the highest standards of coverage among provinces and private payers. Certainly, no model of national pharmacare should result in a lower level of coverage for Canadians who have existing drug plans.

We also support the council’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 national drug agency, if done right, should streamline Canada’s complex drug regulatory processes and should also shorten the time between when a new medicine is approved for use in Canada and when it’s covered by a public drug plan.

For any national pharmacare option to be successful, federal and provincial governments and key stakeholders must work together to ensure patients receive the best standard of care and have access to necessary medicines and treatments.

Any national pharmacare model will be judged by its ability to provide Canadians with timely access to medicines.

Read: What are the implications of pharmacare reform for private drug plans?