Canadians Need Drugs and Pharmacare is the Dispensary

RISING COSTS One in 10 Canadians can't afford to fill their prescriptions, and many people have to choose between paying their rent and getting the medications they need.

It wasn't that long ago when getting access to medicinal cannabis was a clandestine exercise that saw users facing arrests and criminal records. Canadians' push for the decriminalization of the drug goes back many years, but the legal and statutory changes that now protect patients' rights to use it only occurred over the last decade.

Canadians have also been pushing for access to other drugs, namely, prescription pharmaceuticals that are covered under a national insurance plan. But on this front there is still much work to be done.

Canada is the only country in the world with a national public health-care system that does not include pharmacare. Our country's complex, patchwork system of prescription drug funding, with widely varying levels of public and private insurance coverage, means there is uneven access to prescription drugs.

Today, one in 10 Canadians can't afford to fill their prescriptions, and many people have to choose between paying their rent and getting the medications they need.

It shouldn't be this way. For years public health-care advocates have been calling on Ottawa to expand the medicare umbrella to include prescription drugs. And Canadians overwhelmingly agree: a 2015 Angus Reid poll found that 91 percent of Canadians believe our public health-care system should include a universal prescription drug plan.

Not surprisingly, the issue of access to needed drugs was major issue in the 2015 federal election, and last year the Trudeau government opened a "national dialogue" on pharmacare through online public consultations and meetings with stakeholders across the country. Led by the Advisory Council on the Implementation of National Pharmacare that was announced in Budget 2018, the consultation focused on how to implement "affordable national pharmacare for Canadians and their families, employers and governments."

Concerned about the advisory council's mandate of "affordability" and what it might mean for the policy recommendations that come out of the process, public health-care advocates recently developed a statement of pharmacare consensus principles that spells out exactly what "pharmacare" means.

The BC Nurses' Union is now one of the latest signatories to the statement that was issued by a diverse coalition of unions and health-care advocates on Sept. 25. It's a call for a national pharmacare program that, like medicare, is publicly administered, comprehensive, accessible, portable and universal.

"Historically, pharmacare was always intended to be integrated with medicare," says BC Nurses' Union President Christine Sorensen. "But the black eye in the Canadian health-care system is that too many people continue to pay staggering amounts of money for prescription medication."

Half of all adult Canadians take one prescribed medication on a daily basis, she notes. And those over 65 years of age take up to five prescribed drugs per day. On average, individual Canadians spend just under $1,000 on prescription medication per annum.

Canada also has the second-highest prescription drug costs in the world after the United States. According to the Canadian Institute for Health Information, prescription drug expenses have skyrocketed over the last 30 years, from $2.6 billion in 1985 to $33.8 billion in 2017.

"This is unsustainable, and we can only assume it will get worse," remarks Sorensen. She says Canadians need only look south of the border for the evidence. The 2016 EpiPen controversy saw Mylan Pharmaceuticals increase the price of the life-saving injection by 400 percent between 2009 and 2016.

"Pharmacare is not a 'nice-to-have' but a must-have."

 

- BCNU President Christine Sorensen

A public uproar and government intervention led drug makers to manufacture a cheaper generic version. "The US experience shows that pharmacare is not a 'nice-to-have' but a must-have for Canada," says Sorensen.

Nurses, along with physicians and other health professionals, have first-hand knowledge of the human cost of not having universal prescription drug coverage. Every day, they see the harm that comes from patients not being able to afford the medications they need.

The "medication poverty" that results in pill-cutting and skipped doses is also a growing concern for health-care providers. "Missing medication puts patients' health at risk and puts more burden on families, employers and the health-care system," says Sorensen, who notes that someone who is unable to afford an asthma inhaler costing approximately $70 for three months' treatment could end up in hospital at a cost of about $1,000 a day.

A 2017 report from the Parliamentary Budget Office estimates that a single-payer pharmacare system would save Canadians $4.2 billion per year. But some of the money individuals would save from no longer having to pay extended health-care insurance premiums or out-of-pocket costs to drug companies would instead be paid into a national drug plan via progressive taxation.

Implementing pharmacare also means having a government in Ottawa willing to add $20 billion to its annual budget to fund the plan – not an easy order.

The losers in any move to national pharmacare would be the insurance companies currently providing drug coverage through individual and employer health plans, and drug manufactures whose profit margins would suffer as a result of the bulk buying of drugs that governments would leverage in order to save money.

Both groups represent powerful corporate interests ready to fight to maintain the current inefficient and expensive system.

"It's a paradox. While medications have become more effective, we are less able to ensure everyone who needs them has access," says Dr. Steve Morgan, professor of health policy at the University of British Columbia.

But the situation will only worsen without a national, universal prescription drug plan, Dr. Morgan predicts. "Because of the extraordinary and uncontrolled costs of medicines in Canada — we have some of the highest costs in the world — businesses are saying they can no longer afford to provide the kinds of benefits they have in the past."

A government-run, single-payer system is the answer, he says, because only government can bring to bear the expertise and the buying power needed to keep prescription drug costs at a reasonable level.

Sorensen agrees. "As a mother and a nurse, I am afraid of how costly it will be to future generations of Canadians if we continue to ration access to prescribed medication.

"The federal government has an opportunity to be pioneers of pharmacare just as Tommy Douglas, the father of medicare was in his day – it's an opportunity whose time has come."

UPDATE (October 2018)

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