Advocates for national pharmacare have misdiagnosed the nature of gaps in prescription drug plan coverage in Canada and have proposed the wrong solution, according to a new study by think-tank the Canadian Health Policy Institute.

Based on Canada’s 2016 population of almost 36.3 million people, the study found close to 23.2 million had coverage through a private drug plan. The remaining 13.1 million had first- or second-payer coverage under public programs.

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

“The problem isn’t uninsured people, it’s underinsured drug costs,” said Brett Skinner, founder and chief executive officer of the Canadian Health Policy Institute and author of the study, in a news release.

The study also showed that, among Canadians with coverage under public drug plans, nearly 840,000 were eligible for first-payer coverage under the federal non-insured health benefits program, which services First Nations and Inuit citizens. As well, nearly 8.2 million people were active claimants under first- or second-payer coverage in their provincial or territorial public drug plan. At the same time, close to 4.1 million people were eligible as inactive claimants for either first- or second-payer coverage under public plans, according to the study.

Read: Study warns against adopting New Zealand-style pharmacare

Among inactive claimants, the study estimated that more than 2.4 million people in lower-income family groups faced potential exposure to income-adjusted deductibles, copayments or premiums between $0 and $2,000 per family. In addition, more than one million middle-income Canadians faced cost-sharing ranging between $2,000 and $5,000 per family. Furthermore, nearly 600,000 high-income earners faced potential costs of more than $5,000 per family.

The study also suggested that advocates for national pharmacare have misrepresented surveys of Canadians reporting cost-related reasons for not taking their prescribed medication to mean that many Canadians lack coverage under any prescription drug plan.

Read: Ontario health minister resigns to lead discussion on national pharmacare plan

“Those survey results are best explained by exposure to cost-sharing,” said Skinner.

“Simply forcing the entire population into a new national pharmacare plan is not a remedy for reducing under-insured drug costs. It is easier and less expensive to adjust the cost-sharing criteria for existing public drug plan benefits.”

Copyright © 2019 Transcontinental Media G.P. Originally published on benefitscanada.com

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Joe Nunes:

I am not expert in health care – but it seems to me that there will be more and more cost sharing pressures on employer sponsored plans and in the end, bulk purchasing by a national government program might create the lowest cost solution.

The challenge with the national program is deciding who pays how much?

Tuesday, June 19 at 11:06 am | Reply

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