This past week, Canada joined with the provinces to look at bulk-purchasing prescription drugs. That prompted the Canadian Life and Health Insurance Association (CLHIA) to request admission on behalf of health benefit plan sponsors. That makes eminent sense.
A little more than $16 billion of prescription drugs are bought each year by the private sector (plus about $12 funded through provincial and federal medical programs), with about $12 billion covered by insurance and $4 billion paid by individuals.
Read: Employers want to be heard on national healthcare: report
Even if Canada’s governments do invite the CLHIA to the table, that will still leave one group of Canadians standing on the sidelines – those who do not have prescription drug coverage through either employment or government sources.
Many people in that situation are probably unable to consider paying for the cost of drugs if prescribed, unless they are very cheap. Think of all the part-time and contract workers who rarely enjoy eligibility for corporate benefits plans. Then add those who are self-employed who have not bought coverage and everyone between jobs – possibly for months at a time.
Good statistics are missing, so I made a rough estimate that about two-to-three million Canadians have no prescription drug coverage. Are we facing a future when they will be the only consumers paying the undiscounted price for drugs?
The potential expansion of the bulk-purchasing group is a perfect opportunity to include all Canadians as beneficiaries of lower drug prices. But those without government or private insurance coverage do not have a voice and are unlikely to be invited to the discussions.
Read: Private insurers want in on national bulk-buying deal for drugs
We could argue that health minister Jane Philpott should include everyone as part of her mandate, from the prime minister to “work with provincial and territorial governments to support them in their efforts to make home care more available, prescription drugs more affordable, and mental health care more accessible.”
The insurance industry and plan sponsors likely have no responsibility to these Canadians, other than possibly as part of a social consciousness. I would like to see the CLHIA join the governments, as part of their representation of employers and their employees. But the CLHIA could enhance its position and likely increase its chance of joining the bulk-purchasing group if it also speaks for the non-represented.
It would appear that whatever mechanism is used for the purchase and distribution of bulk-purchased drugs, it could easily be extended to include every Canadian through efforts of the CLHIA.
Peter Gorham is an actuary at JDM Actuarial Expert Services