Making "Universal Medicare" Universal: Calling for a National Pharmacare Strategy

In our clinical experiences we regularly see patients burdened by the cost of medicines and unable to fill their prescriptions. We know how aware of this you are from your medical practice too.

We are shocked by how medication costs are determined in Canada. Canadian physicians, residents, and medical students expect healthcare policy in this country to be evidence-based, and we have placed our trust in you to do this. We have the evidence now that a National Pharmacare Strategy would be cost effective, eliminating a long standing barrier to implementation – the belief that a universal publicly funded pharmacare plan would be too expensive. The landmark 2015 article published in the Canadian Medical Association Journal builds on an already robust literature base articulating the need for a National Pharmacare Strategy. The findings of this cost-benefit analysis are that universal public drug coverage would reduce total spending on prescription drugs in Canada by an estimated $7.3 billion [link to study].

Citizens need provincial and federal buy-in for a pan-Canadian solution. As you have said, we need to do things differently. We need to bargain more effectively and revisit our relationship with Big Pharma, not accepting price inflations that are then offloaded onto third party insurers and out of pocket payers. We need to purchase smarter through national bulk purchasing strategies in order to secure lower, more reasonable drug prices. We need to use the best available evidence under the guidance of objective academic drug detailing programs and harness our purchasing power to bring costs down.

During the election, as doctors of tomorrow we sought federal leadership that would return to undertaking pan-Canadian healthcare responsibilities. We have new CMA leadership from a long-serving rural physician, Dr. Granger Avery who, at the Canada 2020 Summit on a new Health Accord reiterated the need for a National Pharmacare Strategy. The CMA has identified that Universal Pharmacare is an integral component of a high performing system that cannot be ignored; it is a tenet underpinning every area of healthcare and would have the most substantial impact of any changes made to our system. With the billions saved, funds could be redirected towards home care, care of the elderly, care of Indigenous populations, and comprehensive mental health services. Consistent with the universality and equitable accessibility promised by the Canada Health Act, a National Pharmacare Strategy would be the epitome of action to fulfill Prime Minister Trudeau’s words of establishing strong national unity.

As you have said, the last time a doctor was the Minister of Health was perhaps nearly a century ago. We appreciate your efforts to take steps towards lowering costs that Canadians face for their medications. This includes working to install regulatory changes to the way drug prices are set in Canada, and working with the Patented Medicine Prices Review Board. It is actionable steps like this that will pave the way toward Universal Pharmacare in our future. Yet, in order to most effectively move towards a goal, it needs to be stated with clarity and conviction. The current medico-political climate is unique, Dr. Philpott. We have informed physicians in leadership roles with awareness of evidence, relationship-building capacities to forge new alliances, and abilities to mobilize changemakers. We need to be bold and “think big” to make real change happen. Thus, we urge you to draw on your courage, seize this critical time in our Canadian history and commit to a National Pharmacare Strategy. If you don’t, who will?

#makecanadianuniversalmedicareuniversal

Visit a recent CBC Fifth Estate episode on Canada's Drug Problem (http://www.cbc.ca/fifth/episodes/2016-2017/the-high-cost-of-phamaceuticals-canadas-drug-problem) and Minister Philpott's full interview (http://www.cbc.ca/fifth/blog/full-interview-with-minister-of-health-jane-philpott).

See http://pharmacare2020.ca/ for additional information.

Additional Reading:

- Canada is the only country in the world that prides itself on universal healthcare, yet contradictorily does not have universal medication access. Canada has 19 publicly funded drug plans and over 1000 private insurance programs: a fragmented, non-equitable patchwork that leaves many uncovered. We spend 30% more on drugs than nations with Universal Pharmacare programs!

- Canadians spend more than $700 US per capita for prescription, non-prescription, and personal health supplies, whereas the average per capita expenditure for OECD countries is $500.

- In a recent Angus Reid Institute national survey nearly 1 in 4 Canadians did not take a prescribed medicine because she/he could not afford it. Food and shelter costs undermine medication costs when it comes to day-to-day survival. Inadequately treated chronic disease inevitably decompensates. Hospital admission for acute disease management then culminates in hefty inpatient costs.

- Our generic drug prices are dependent on patented drug prices, established as the median of seven comparator OECD nations. This list includes the four places on the globe where drugs are most expensive.

- Prices for the same medicines vary depending on province or territory of residence. In order to make drug prices more appealing to provincial and territorial governments, pharmaceutical companies artificially inflate prices to present the government with a “discount price,” whilst channeling the cost burden to third party insurers (10% higher costs compared to government costs) and most significantly to out of pocket purchasers, many of whom are the working poor.

- Take the price of the common cholesterol medication, atorvastatin, which is cheapest in Ontario and costs 31 cents. Compare this to that same pill in New Zealand, which costs 2.6 cents!