In last week’s report on pharmacare, the House of Commons’ standing committee on health recommended a significant departure from the current mix of private drug coverage supplemented by public programs.

While the report referenced various provincial drug programs that supplement private benefits plans or cover those without their own insurance — including those offered by Quebec, Alberta, Prince Edward Island and New Brunswick — the committee instead recommended a national single-payer pharmacare plan. While there would be a voluntary national formulary, the provinces would administer pharmacare coverage with federal financial support.

Read: Commons committee recommends national pharmacare program

As Steve Morgan, professor of health policy at the University of British Columbia, points out, the committee is essentially recommending a rethink of how drug coverage in Canada works.

“I think what the narrative that we’ve seen in the public reporting or the government reports and even in the Liberal party convention, was that revising Canadian pharmacare or the models that we have at the provincial level is necessary because every one of our systems, no matter what the province you look at, including Quebec, does a number of things that create problems in terms of increased costs, financial inequity and system-wide inefficiencies,” he says.

Morgan cites three key issues with the existing system: diminished purchasing power caused by a fragmented market, charges imposed on patients through out-of-pocket payments, deductibles and co-insurance and the isolation of prescription drug management from other health-care components.

Read: Budget confirms new advisory council on implementation of national pharmacare

“For those three reasons . . . all of those things speak to the idea of rethinking pharmacare, rethinking public drug benefits . . . moving away from a model that says, ‘Let’s just focus on which particular Canadians should receive public drug coverage for all of their needs and then leave other people to the private system.’ [The committee is suggesting] changing that to say, ‘Why don’t we think about which particular drugs are sufficiently deserving that every Canadian should be covered for them and then things outside of that envelope can be left to the private system,’” he says.

Private health plan strategist Suzanne Lepage, however, notes the advantages of the current mix of public and private coverage.

“I believe that we need to provide access to people who don’t have coverage, but where private coverage exists, people benefit from it and I think that we should potentially leave it as is and fill in the gaps, rather than replacing everything,” she says.

Noting that private coverage is often more extensive than what public programs offer, Lepage warns of the downsides of a shift to a universal plan.

Read: The great pharmacare debate: An ‘overly simplistic’ solution or needed system rationalization?

“Second, and the other key differentiator, I think, is what employers might value would be different than what the government would value in terms of which drugs should be covered. And so therefore, would an employer be well-served by a government-driven drug listing?” she asks, noting employers tend to emphasize getting people back to work as quickly as possible and keeping them there.

Helen Stevenson, president and chief executive officer of Reformulary Group Inc., says that from a practical perspective, programs that address the gaps in coverage would be the ideal solution. In her view, the examples of the four provincial plans given in the standing committee report are a viable alternative. She says that while the public plans would likely have to change from their current iterations, the policy objective of providing coverage for those who don’t have it is probably what’s most important.

“I think that’s what we’re trying to solve. On that basis, that’s a very viable solution, and it’s infinitely more feasible than just blowing everything up and starting over and creating one plan,” she says.

What do you think? Is the current mix of private and public coverage a better way to address access to prescription drugs in Canada? Should a solution focus on filling gaps rather than replacing the system? Or is a universal, single-payer program a better way to address drug coverage? Have your say in Benefits Canada‘s online poll.

The last poll question asked whether it was time for investors to revisit their expectations for equity returns in the face of a mature bull market. Three-quarters of respondents agreed, suggesting the market is far enough into the cycle that scaling back on equities in favour of broader diversification is sensible. The remaining 25 per cent said that while potential market challenges will have an impact on a broad range of assets, there’s still room for equities to deliver strong returns.

Read: Have your say: Is it time for investors to revisit their expectations for equity returns?

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The answer is probably a combination and not either of the choices independently. The current provincial formularies are very different from each other and some standardization is needed. A more common program for all provinces would help significantly in bulk purchasing. Using the provincial plans in coordination with employer plans makes ultimate sense as they are typically quite varyingly different. The National program would cover the gaps above what the provincial programs could finance and anyone missed and after coordination with employer plans. The national program would be like a top up plan or last stop loss payer. Pharmaceutical companies could drop their programs of cost assistance and join in at the national level to offset high costs. Whole thing would work better.

Wednesday, April 25 at 1:25 pm | Reply

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