Canadian medicare needs an Rx

By Steve Morgan

78% of Canadians support coverage to include medically necessary prescription drugs

A version of this commentary appeared in the Medical Post, Hamilton Spectator and the Waterloo Region Record

PrescriptionPolls show that most Canadians cherish the underpinning ethics of our medicare system: that healthcare should be allocated on the basis of need not ability to pay. But polls also show that Canadians want more from the system.

The list of potential improvements is long. Public opinion and research evidence point to areas such as improving primary healthcare, reducing wait times and being more proactive about health promotion and disease prevention.

One health system improvement seems to be capturing increasing attention of the public, health professionals, unions, employers and experts. It is to make medicare more comprehensive by expanding coverage to include medically necessary prescription drugs.

A poll released last week by EKOS Research Associates found that more than three-quarters (78%) of Canadians would support expansion of public drug coverage to make “Pharmacare” in Canada operate like our medicare system.

Canadians have good reasons to want such reform. Every developed country with a universal healthcare system provides universal coverage of prescription drugs… except Canada.

Drug coverage is provided in all comparable healthcare systems because, when prescribed and used appropriately, prescription drugs can be among the most cost-effective forms of providing healthcare. The architects of these other systems know that charging patients for prescriptions will impede the use of essential medicines — which can cost the healthcare system in other ways, such as increased hospitalizations.

In Canada, many patients cannot afford to take medicines prescribed by their doctors. The recent poll by EKOS suggests that, in the past five years, about one in five Canadians (23%) have chosen not to fill a prescription because of out-of-pocket costs. That’s a lot of missed prescriptions.

Such access problems are prevented when medically necessary prescriptions are covered as part of the healthcare system. Countries with such access every other developed country with universal healthcare — also spend considerably less on pharmaceuticals than Canada does. This is because healthcare systems that purchase medicines on behalf of entire populations have significant bargaining power in price negotiations with drug manufacturers.

Managers and prescribers in such systems also have incentives to view medicines as part of healthcare as whole. Allowing high prices or over-prescribing ultimately reduces resources available for other forms of patient care because costs cannot simply be passed onto patients, employers, unions or other actors as is too often done in Canada by way of reduced drug coverage, increased patient charges or increased insurance premiums.

The United Kingdom provides a good example of integrated health and pharmaceutical coverage. There, the public healthcare system provides universal coverage for medically necessary prescriptions at little or no cost to patients. It works. Citizens of the UK report virtually no barriers to access just 2% of the population reports skipping prescriptions because of cost.

Instead of asking patients to consider costs, the system in the UK asks doctors to do so by connecting prescribing budgets with budgets for medical and hospital care. That works too. Their prescribers rely less heavily on newer, more costly drugs when older treatments might do as well or better.

As a single-payer system, the UK also obtains much lower drug prices than we do in Canada. Brands are roughly 30% cheaper and generics are 30% cheaper. Yet, it is worth noting that the UK attracts more than 5 times as much pharmaceutical R&D on a per capita basis than Canada.

Put another way, if the per capita costs of pharmaceuticals in Canada were the same as the UK, we would spend $14 billion less on medicines every year. That is enough to pay annual salaries for 180,000 new nurses in Canada an increase of our nursing workforce by 50%.

Canadians are justifiably proud of the basic structure and ethics underpinning our medicare system. But a growing number of us are realizing that the system is uniquely incomplete.

Pharmaceuticals are integrated into every other universal healthcare system in the developed world. It’s time to do the same for Canada.  We could begin with clear winners for patients and the health system such as covering drugs to manage cardiovascular risks, diabetes, asthma and severe mental illness.

If we fail to do so we will continue to pay more to get less.

Steve Morgan is an expert advisor with EvidenceNetwork.ca and Associate Professor and Associate Director at the UBC Centre for Health Services and Policy Research.

See the two posters, 1 and 2 based on this commentary

June 2013

This Commentary is from Commentaries, Pharmaceutical Policy.

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