A version of this commentary appeared in the Toronto Star

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Medication access may help to decide an election for the first time in Canada — it is one of several prominent issues garnering public attention as Ontarians head to the polls June 7th.

The Ontario NDP have pledged to publicly fund a short list of prioritymedicinesfor all Ontarians.  The PC party has said little about prescription drugs and will focus healthcare reforms in other important areas, such as increasing the number of beds in long-term care facilities and investing in mental health services. And the Liberals have recently created a pharmacare program for Ontario children and youth and expressed support for expanding access.

As a medical doctor, I treat patients who have trouble affording even relatively inexpensive treatments for high blood pressure and diabetes — drugs that we know can reduce the risk of heart attacks and deaths. Insulin was discovered in Canada almost a hundred years ago, but many Canadians with diabetes cannot afford it, such as those with low-income jobs in factories or restaurants who do not receive social assistance and who are not offered private insurance by their employers. I also conduct research on medication access so I may have a skewed view of the importance of the issue.

But calls for universal pharmacare are frequent in the media and never far from Canadians’ wish-lists. So how do the party promises compare?

The Ontario PC party is right to be wary of including medications in our publicly funded system. Most governments and parties in Canada tread carefully in this area for good reason. While millions of Canadians either cannot afford medicines or know someone who can’t, people are also legitimately concerned about moving most drug spending onto the public books. Total annual drug spending is more than $25 billion across Canada.

The federal government, for example, continues to be non-committal and after a years-long parliamentary study of national pharmacare, announced yet another new year-long study on the issue.  An agreement with the Green Party in British Columbia that put the NDP in power mentioned creating a public drug plan for people who cannot afford medicines, but those plans have not yet materialized.

So the Ontario PC party is in good company — of different political stripes — in focusing up front on more clear cut health issues, such as emergency room wait times.

Yet the case for pharmacare has been clear for a long time and millions of people have suffered while we wait because they can’t afford their prescription drugs.

One reason for the slow progress across Canada — regardless of which party is in power — is the amount of money that would be saved. Yes, saved.  Publicly funding medicines will actually decrease total drug spending by billions of dollars by reducing drug prices through stronger negotiating positions and through better evidence-based medicine selection.

My colleagues and I have estimated the savings at over four billion dollars per year and the staid Parliamentary Budget Office provided a nearly identical estimate. Each dollar saved is a dollar of lost profit for powerful pharmaceutical and insurance companies. So, despite decades of government and academic reports supporting the public funding of medicines, we are still batting around proposals to do it.

There are real differences between the two Ontario parties that do promise to tackle the issue.

The Liberals have already funded a large number of medications for a narrow segment of the population, those under age 25, and they support expanding complete publicly funded access to those 65 and older.

The NDP have promised to publicly fund a smaller number of medicines for the entire population. Funding more drugs is bound to be more popular since it will leave medication selection up to doctors (who may or may not choose wisely) and perhaps also to patients. Funding fewer, but essential medicines for the whole population may prevent inappropriate medicine use and it will undoubtedly cost less.

But the number of medicines covered is not actually the most important issue.

Both proposed plans will provide access to medicines that people need and both will eventually reduce overall drug spending. Most importantly, both will eventually mean that whether you can take a life-saving treatment will no longer depend on the type of job you have.

Conventional wisdom says that when you are alone in the ballot box, you will make the choice that is best for you. So the Ontario election results may well indicate what Ontarians think about putting medicines within our publicly funded healthcare system.


Nav Persaud is a family physician and an assistant professor at the University of Toronto and an expert advisor with EvidenceNetwork.ca.

June 2018

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