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CanadaNational pharmacare plan a political pill or cure-all?

09:45  14 june  2019
09:45  14 june  2019 Source:   macleans.ca

Expert panel recommends Canada implement single-payer pharmacare plan

Expert panel recommends Canada implement single-payer pharmacare plan OTTAWA — An expert panel is calling for the federal government to work with the provinces and territories to create a single-payer national pharmacare plan to cover every Canadian. Eric Hoskins, Ontario's former health minister, released the findings in Ottawa, giving advice on how to address the country's patchwork of private and public prescription-drug plans. Canada has a variety of drug plans administered by provinces, mainly for children, seniors and people on social assistance. Other plans managed by the federal government cover other groups, such as Indigenous people and members of the military, while private insurance fills the gaps for some.

Anne Kingston: These are still just recommendations. But now that the spotlight has turned on Medicare’s incomplete mandate, it will be difficult for politicians to step away.

Expert panel recommends Canada implement single-payer pharmacare plan . OTTAWA — An expert panel is calling for the federal government to work with the provinces and territories to create a single-payer national pharmacare plan to cover every Canadian.

National pharmacare plan a political pill or cure-all?© Used with permission of / © Rogers Media Inc. 2019. Dr. Eric Hoskins, Chair of the Advisory Council on the Implementation of National Pharmacare, June 12, 2019. (Sean Kilpatrick/The Canadian Press)

Canada inched toward the introduction of a universal, single-payer, public, national pharmacare system this week with the release of long-awaited recommendations from the Advisory Council on the Implementation of National Pharmacare. Coming as it does on the eve of the federal election, the 171-page report is already campaign fodder. Public support for universal pharmacare in this country is very high—84 per cent of Canadians are for it, according to a recent Environics public opinion poll. The NDP have long called for a similar plan. The report wasn’t out an hour when Conservative leader Andrew Scheer used it to slam the Liberals:  “I have zero confidence in their ability to handle this,” he said.

Impeccable timing turns the fall election into a referendum on pharmacare

Impeccable timing turns the fall election into a referendum on pharmacare Eric Hoskins says the time is right for Canada to create a universal pharmacare system. The timing of his report calling on the federal government to finally do that might not be so bad, either. "We know (pharmacare) is going to be part of the fall election campaign," the former Ontario health minister said in an interview Wednesday on the podcast edition of The House. "So for me, there is no better time to have this discussion than with all Canadians in the context of politicians asking for their support. This is such a profound and important part of our conversation that it deserves that attention.

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The Liberals cast pharmacare as an election platform at its policy convention in April 2018 when it voted for “a universal, single-payer, evidence-based and sustainable public drug plan,” with the proviso it required “provincial and territorial co-operation.” The advisory council, chaired by Eric Hoskins, a medical doctor and former Ontario Health Minister, had been convened after the 2018 budget. At that time, Finance Minister Bill Morneau said any national drug program would have to be “fiscally responsible” and designed to fill gaps in coverage — not to provide prescription drugs to Canadians already covered by existing plans.

The advisory council saw otherwise. Its report calls for a $15-billion universal plan covering all Canadians, and the creation of a new national drug agency that would draft a national list of prescription medicines covered by the taxpayer and also negotiate prices. An initial list of “common and essential drugs” would be drawn up by Jan. 1, 2022, then expanded to a comprehensive plan by Jan. 2, 2027. Once implemented, the program would save an estimated $5 billion annually in drug costs, Hoskins announced at a press conference.

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Healthcare practitioners and researchers who supported universal drug coverage have greeted the report favourably. “Canada’s nurses applaud the findings,” the Canadian Federation of Nurses Unions announced in a statement, calling them “a victory for Canadians!” The proposed plan would bring “an end to the current costly and dysfunctional patchwork system of coverage,” the group stated.

Physician and drug researcher Joel Lexchin, co-author of Pharmacare 2020 and professor emeritus at York University’s School of Health Policy & Management, calls the recommendations good news, with a few caveats: “I was pleasantly surprised given what Morneau said last year about the fill-in-the-gaps kind of approach,” he tells Maclean’s.

But Lexchin also expresses frustration that it has taken so long to get this far. Prescription drug coverage was part of the country’s original 1964 Medicare plan. “There wasn’t political will,” he said. The lack of drug coverage, like the lack of dental coverage, has come at high cost, human and financial. A 2016 Canadian Community Health Survey revealed that approximately 20 per cent of Canadians (as many as 7.5 million people) don’t have prescription drug coverage. Approximately one million Canadians said they’ve had to choose between food and heat or a needed prescription. The survey also revealed that even those with drug coverage can face significant, often prohibitive out-of-pocket expenses— deductibles, copayments and annual or lifetime maximums. (The advisory council’s recommendations include copays of $2 for drugs on the “essential medicines” list and $5 for other drugs (with exemptions for the poor and a limit of no more than $100 per year per household.))

NDP promise to expand universal health care, starting with national drug plan

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Renewed discussions on plans for a “ national ” or “pan-Canadian” pharmacare program have shown that the concept of “ pharmacare ” means different things to different people. Discussions typically center on access and equity (coverage), the drug prices paid by Canadians, a common formulary, and

National pharmacare plan a political pill or cure - all 13.06.2019 · National pharmacare plan a political pill or cure - all ? Anne Kingston: These are still just recommendations. But now that the spotlight has turned on Medicare’s incomplete mandate, it will be difficult for politicians to step away.

“It’s shameful that we’re in this situation,” Lexchin says. “We could have done something about it decades ago.” He views the proposed timeline as problematic: “They could have had the full plan in place before 2027,” he says, noting that the roll-out running beyond a single government mandate puts it at risk.

The major argument for a single-payer system is the cost efficiencies; it offers leverage to play hardball with drug companies at a time drug price increases are “unsustainable,” to quote the advisory council’s interim report. Canadians pay the  highest drug prices of any country with a universal health care system, with prescription drugs the second largest category of health care spending behind hospitals. Costs have risen from $2.6 billion in 1985 to $34 billion in 2018, with increases to more than $50 billion expected by 2028. Canada’s per-capita drug spending is the third-highest in the developed world, behind only Switzerland and the United States, according to the federal drug-pricing regulator.

The estimated saving of $5 billion annually could be on the low side, Lexchin posits. “It’s reasonable to assume we’ll get better bargaining on brand name drugs and better use of generics because a lot of the private plans don’t require generic substitution and we’ll save money on administrative costs. We’ll have to wait and see.” Lexchin wasn’t happy to see the inclusion of copays: “Even small copays discourage people from getting the medications that they need,” he says: “We saw that in Saskatchewan in the ’60s when they had a $1.50 copay on visiting doctors; it affected low-income people.” Wales and Scotland, countries less well-off than Canada, eliminated copays, he notes.

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They all recommended such a program because it is the most equitable and affordable way to ensure universal Canada has a plan . The latest major government report on pharmacare – the June National pharmacare does not need to be studied further before proceeding with implementation.

A national pharmacare plan could save Canadians .3 billion per year. We asked Martin to outline the greatest barriers to affordable, regulated drugs for all Canadians under our current system — especially for women — and why she believes a nation -wide prescription plan could resolve them.

The advisory council’s report also called for a detailed national strategy by 2022 to fund drugs for rare diseases that can run into the hundreds of thousands of dollars annually;  Lexchin points to Novartis’s $2.1 million gene therapy for spinal muscular atrophy. No country in the world has been able to get a grasp on the exorbitant, rising prices in this area, Lexchin says. Canada can’t do it alone, he says, calling for coordination with other countries to put pressure on drug companies and make them accountable: “No one has said: ‘How much do you spend on R&D? What are your manufacturing costs? Show us the numbers’.”

Alan Cassels, a drug policy researcher at the University of Victoria who has written extensively about overprescription and inappropriate prescription of drugs, is pleased with the report’s recommendation No. 36, which calls for more “appropriate” prescribing of essential medicines. “Before you even get into the cost of drugs, you have to dive into the issue of appropriateness of drugs,” he says. “And right now so much prescribing information that physicians get is tainted by industry influence or ‘expert opinion’ not based on evidence.” He cites B.C. as a model for coverage decisions being based on evidence. “As with all government purchasing, you want good comparison shopping,” Cassels says. “You want them to say, ‘Yes, we’ll pay for that new drug that’s $1,000 a month, but it better be a lot better than the old one that’s $10 a month’.”

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Pharmacare or universal health care aims to fill the gaps to improve access to prescription drugs . Every developed country in the world that has a universal Raza said his patients are the working poor who work part-time in precarious jobs and don't qualify for a public plan . Is pharmacare affordable?

Single-payer healthcare is a type of universal healthcare financed by taxes that covers the costs of essential healthcare for all residents, with costs covered by a single public system (hence 'single-payer').

Creating an “essential medicines” list will be a challenging, time-consuming first step, Cassels says, noting that Canada has some 13,000 prescription and non-prescription drugs, yet the World Health Organization only lists 433 “essential medicines.”

Another predictable challenge will be funding. This week’s report included no proposed cost-sharing agreement, only that pharmacare will be negotiated with the provinces, a process destined to be fractious. The provinces would be all for a national plan if the federal government pays for it, says Lexchin. “But when you get into these cost-sharing agreements, how much do you have to bribe the provinces in order for them to participate? That might discourage some provinces from coming into the plan.”

As the nurse’s federation statement put it: “The ball is now in the Trudeau government’s court to make this a federal election priority and to move as fast as possible towards full implementation.” In a statement, Health Minister Ginette Petitpas Taylor didn’t appear to be in a hurry. The government will carefully review the report and recommendations “in the coming months,” she said, noting the feds “remain committed to implementing national pharmacare in a manner that is affordable for Canadians and their families, employers, and governments.” The Health Minister said she looked forward to working with the provinces and territories and other stakeholders “as we consider next steps.”

Those steps are destined to be shadowed by both political and industry demands. Lexchin expects drug companies to put pressure on the U.S. government, which in turn will put pressure on Ottawa. Cassels, too, expects a major fight from drug companies: “They depend on disorganized, chaotic provincial/private coverage to maximize profits.” After watching decades of lack of political will, Lexchin is circumspect. “These are still just recommendations,” he says. That’s true. But now that the spotlight has been thrust on Medicare’s incomplete mandate, and its myriad costs, it will be difficult for politicians seeking election to step away.


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    Medicine shortages feared as Trump backs Florida, Colorado laws to import Canadian drugs in bulk.
    It is a state with 21 million people, a huge concentration of medicine-consuming senior citizens and massive influence in the next U.S. election. 

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