Any decision reached on pharmacare reform in Canada should guarantee the viability of current health benefits plans, according to the Canadian Life and Health Insurance Association in its submission to the advisory council on the implementation of national pharmacare.
Jeopardizing current benefits plans could lead to a delay in access to new medicines and could potentially put Canadians at risk of challenges accessing the medications they need, noted the submission.
The CLHIA also recommended any reform to pharmacare makes good use of taxpayer money. “As such, we recommend a model that leverages the existing system of public and private coverage going forward as it creates the least fiscal drag for governments while still reducing overall costs and meeting the key policy objectives of improving access,” the association wrote.
Among its recommendations, the CLHIA suggested the establishment of an evidence-based minimum standard formulary on a national level. “It should provide for coverage of both chronic illnesses and drugs for rare diseases and set maximum allowable out-of-pocket amounts, possibly based on income, for all Canadians. We recommend that the government work with industry to develop a solution.”
Also to that end, the CLHIA recommended the government works with the industry to set up a national risk-sharing model for high-cost drugs, helping to ensure employers and provinces can afford to meet the minimum standard formulary.
It also suggested workplace benefits plans remain tax exempt, which protects the incentives for employers offering these plans to staff.
The advisory council should look at pharmacare plans in Quebec, British Columbia, Saskatchewan and Manitoba as adaptable examples for a national program, noted the submission. It also recommended the pan-Canadian Pharmaceutical Alliance negotiates lower prices on branded drugs and leverages the buying power of the public and private payers to achieve this goal.
“We would support allowing Canada’s insurers to join or leverage the pCPA in the very short term — even in advance of, or in the absence of, any national pharmacare reform,” stated the submission.
Lastly, the CLHIA said it supports the Patented Medicine Prices Review Board reforms, and suggested the new regulations are put in place as soon as possible.