While a national pharmacare program is yet to be revealed by the federal government, any future plan should contain provisions for all costly treatments and not just rare diseases, says Jennifer Schmidt, a principal at Mercer Canada.
This week’s federal budget announcement contained only a passing mention of pharmacare, with the government reiterating its commitment by stating it will proceed with a previously-announced $500-million funding program for high-cost drugs used in treating rare diseases. The government will also directly engage with willing partners on national universal pharmacare, alongside other important health priorities that can be advanced at the provincial and territorial level, the budget said.
Federal NDP Leader Jagmeet Singh noted pharmacare was largely overlooked in the 2021 spending plan, with the NDP leader arguing the Liberals chose to please “Big Pharma” over working families. While a federal election is not immediately on the horizon, when one does occur the ultimate shape of any national pharmacare program could change substantially depending on the outcome of any future election.
Schmidt says Mercer has advocated for what it calls an “ultra-high cost” treatment strategy — one that includes both medication for rare diseases and expensive treatments such as gene and cancer therapies — on behalf of private plan sponsors.
“It’s affecting the market mobility of private plans because carriers look at a group and if there’s a number of people on these high-cost treatments, [the carrier] may exclude them from pooling protection or decline to quote.”
In addition, she says a pharmacare plan should also provide flexibility to plans sponsors to account for differences between geographical regions and industries. “It should allow flexibility to tailor their plan and to support the well-being of their population, in a way that fits their culture, industry and environment.”
Schmidt says Mercer is also advocating for the inclusion of an income-tested insurance program to ensure that all Canadians have access to a national, evidence-based formulary. “Part of it is sustainability pressure and market mobility, but part of it is also equitable access for Canadians — a consistent national access that’s evidence-based, so that it’s not a case of someone in one province having access to a drug versus someone in another province.”