Calls to include prescription drugs in Canada’s universal health-care system have existed since the 1960s, yet people across the country still have to pay out of pocket for prescription medicines. With the federal election looming, health experts are hoping that political leaders will finally heed those calls. To date, only the Green Party of Canada has made national pharmacare part of its official election platform.
“Canada is the only developed country with a universal health-care system that does not provide universal coverage of prescription drugs,” Steve Morgan tells the Georgia Straight by phone. Morgan is a professor in UBC’s school of population and public health and one of six lead authors of the July 15 report Pharmacare 2020: The Future of Drug Coverage in Canada. “So if you lived in any comparable country—in the U.K., any European country, Australia, or New Zealand—this wouldn’t cross your mind because the system would be there for you.
“We hope that the federal parties will speak to this. To be completely honest, we’ve been waiting for this since the 1960s, when the Royal Commission on Health Services recommended we have universal drug coverage. So we’re hoping that a federal party will say the time has come. I implore the parties to step up, because this is a win-win. Citizens win and the economy wins. It just requires leadership.”
Pushback, he says, comes from groups that stand to lose money, such as drug manufacturers, which are currently able to charge more for drugs in Canada than in other developed nations, and the private insurance industry. However, a universal system would not eliminate the need for private insurance altogether; there would still be a demand for private coverage of drugs not deemed medically necessary and private companies could still play administrative roles. Alberta Blue Cross, for example, administers several health programs on behalf of the government of Alberta.
The Green Party has adopted the four key recommendations of Pharmacare 2020, which has been endorsed by more than 110 experts in the fields of health policy, health economics, medicine, pharmacy, nursing, and psychology: universal access to necessary medicines, fair distribution of prescription-drug costs, safe and appropriate prescribing, and maximum health benefits per dollar spent. It has also stated it will work with other parties to implement those recommendations and make national pharmacare a reality.
Hedy Fry, Liberal candidate in Vancouver Centre, says her party supports a comprehensive pharmaceutical strategy.
“A fairly large number of Canadians can’t afford to buy the medicines they need,” Fry says by phone. “We recognize it, and as a physician I see it. We would like to talk about a pharmaceutical strategy, not just pharmacare. But we are committed to a pharmaceutical strategy.
“Taking your medicines is a core part of treatment,” she adds. “But there are other pieces we feel need to be addressed, and one of the pieces is that it takes so long to get a new drug on the market. There’s a huge logjam at Health Canada. The efficiency of what Health Canada does is something that needs to be looked at.”
Neither the Conservative Party of Canada nor the federal NDP responded to the Straight’s request for an interview.
Many Canadians of all ages can’t afford their prescription drugs, and they’re compensating by skipping doses, splitting pills, or simply not filling their prescriptions, according to a July survey by the Angus Reid Institute. Conducted in partnership with Mindset Social Innovation Foundation, a Vancouver-based registered Canadian charity, it found that 23 percent of Canadians reported that they or someone in their household had taken one or more of those approaches to saving money on medication in the previous 12 months. And more than one in three said they have friends or family members who have difficulty paying for their prescriptions.
In some cases, Canadians can’t afford their prescriptions because they have no drug coverage, but even patients with insurance can experience financial barriers when they must pay deductibles and copayments.
The Angus Reid survey also found that 91 percent of Canadians support the concept of having pharmacare provide universal access to necessary medicines; 89 percent believe pharmacare should be a joint effort involving provinces and the federal government.
The case for universal drug coverage is one where clinical, ethical, and economic considerations all align, Morgan says. If people can’t afford to take their medications, their health declines, which costs the public system more because of the need for other treatment and services, including hospital visits. But that’s not all. Without a universal pharmacare program, Canada loses its purchasing power on the world market for pharmaceuticals. A universal drug-coverage program would save Canada approximately $7 billion a year, Morgan says.
“There is no other proposal in this federal election campaign saying, ‘We will save you, as Canadians, billions of dollars every year,’ ” he says. “We actually can afford [national] pharmacare. In fact, we can’t afford not to do pharmacare.”
Premiers from across the country support national pharmacare, and at the end of August the Canadian Medical Association’s general council voted 92 percent in favour of a universal program. Even municipalities are starting to speak out. On August 25, the City of Burnaby adopted a resolution calling for a universal health-care system that includes the cost of prescription medicines.
What’s needed to make universal drug coverage reality, Morgan says, is political will at the federal level and public insistence.
“You need a federal government that wants to show leadership,” Morgan says. “Paul Martin is the only serious contender for prime minister who ever used the word pharmacare in a federal election.…What will mobilize [Thomas] Mulcair or [Justin] Trudeau to put this into their platform? They haven’t, frankly, because they’re worried about opposition from powerful stakeholders.
“What will motivate them is the fury of the general public who will say, ‘We no longer wish to have a government that won’t stand up for us. We want change.’ What will motivate government is when the average Canadian says, ‘We can’t tolerate this any longer.’ ”