From Ontario’s lips to the feds’ ears
A version of this commentary appeared in the Hill Times and the Huffington Post.
The Ontario government’s decision to invest in universal drug coverage for those under 25 is a long-needed policy commitment that will help ensure the health of our next generation. As a pediatric oncologist, I see children every day who struggle to gain access to the medicines they need. These medicines range from those for serious common conditions such as asthma, to those for rare but chronic or life-threatening conditions, like cancer.
A major barrier to access is cost.
Canada is an outlier for not having a universal program for prescription drugs for children and for allowing wide inter-provincial variation in how public drug plans serve children. This means that many families can’t afford to pay for the essential medicines that their children need to get healthy, stay healthy and grow up healthy.
One in five Canadians foregoes taking prescription medicine due to cost.
Essential medicines are crucial in children, not only to treat medical issues in the here and now, but to help ensure that they have the chance to grow and develop to their full potential. In terms of bang-for-buck, it is hard to argue with investing in the health of children: curing and caring for children now will maximize their chances of growing into the healthy, productive citizens that will define our collective future.
Universal prescription drug coverage for children would save money both now and in the future. In the short term, a universal, public system for drug coverage would reduce drug costs through the increased purchasing power that comes with bulk procurement. In the long term, Canada would benefit considerably from the developmental gains reaped by healthy children.
Reliable and sustained access to necessary medicines is crucial to the control of childhood diseases such as asthma, diabetes, cancer and immunologic disorders. Optimal disease management both improves survival and minimizes late effects. With time, this lays the foundations for a healthier and more productive society.
But more needs to be done.
This budget commitment by the Ontario provincial Liberal government is a laudable step in the right direction, but should be seen as just that: a first step. It is crucial to note that this will not solve all the problems of drug access in Canada, and not even in Ontario — neither for children and their families, nor for the millions of adults who struggle with paying for the drugs that their doctors prescribe.
For children, careful attention will need to be given to which drugs are making it onto our provincial formularies for coverage, which drugs are not, and why. How to deal with novel drugs for childhood illness is a crucial part of this.
As an oncologist, I witness the enormous promise of new drugs for hard-to-treat cancers in children firsthand. Many of these new therapies have the potential to increase the chance of cure and reduce the horrible side effects of traditional chemotherapy. Frequently costing thousands of dollars per year, such specialized medicines for rare and often life-threatening pediatric diseases impose a financial burden that no family should be left to bear on its own.
Unfortunately our systems for deciding which drugs to cover publicly are not well set-up for children. Going forward, careful study of persistent gaps in drug coverage and access, and of the policies governing which drugs are selected for public coverage, will be very important to understanding the success of Ontario’s policy.
A universal pharmacare plan for children must also be thoughtfully integrated into our health care system. Beyond improved access, such a plan has the potential to maximize the safety of pediatric drug use. How?
Off-label prescribing of drugs in childhood — when a physician prescribes a medication to treat a condition or an age group different from that for which it is approved — remains a significant problem, due largely to gaps in evidence. Universal public drug coverage can promote prescribing in line with pediatric guidelines and could incentivize the development and organization of evidence in areas where knowledge gaps persist.
And let’s think bigger. To truly capitalize on its potential benefits — to the health of individual Canadians and our health care system writ large — pharmacare needs to be both universal and national in scope.
If scaled nationally, pharmacare for children would harmonize coverage across provincial jurisdictions. This could, in turn, spur the development of a national formulary for children to provide the evidence base for rational use and funding of pediatric medicines. This would boost evidence-based prescribing for children across the country, and result in enhanced drug safety and efficacy for children regardless of where they live.
Starting with kids is a politically pragmatic, economically sound, and morally defensible first step toward universal pharmacare. Now we need to study and scale it. From Ontario’s lips to the feds’ ears.
Dr. Avram Denburg is a staff oncologist at Sick Kids, a 2015 Trudeau Scholar and an expert advisor with EvidenceNetwork.ca.
Dr. Wendy Ungar is a senior scientist at the Hospital for Sick Children and a professor in Health Policy, Management and Evaluation at the University of Toronto.