Canadian pharmacare: an ongoing failure
At this time of year, most Canadians are stocking up for the holidays. But a surprising number will also be stocking up on prescription drugs. This is not because they believe in doomsday predictions or because they are abusing the health care system.
It is because, for a growing number of Canadians, prescription drug coverage only kicks in after their drug costs have exceeded high deductibles. Those Canadians may even be considered “lucky” in our health care system.
This is because the Canada Health Act – the law that sets the standard for "Medicare" programs in all provinces – does not include prescription drugs outside the hospital setting. As a result, universal public coverage for necessary health care in Canada ends as soon as a doctor hands a patient a prescription to fill.
There are a variety of provincial drug programs in place, but no public drug plan in any province covers even half of the total costs of prescriptions filled outside hospitals. Instead, public drug plans limit their coverage to specific populations – seniors and social assistance recipients – or to expenses that exceed high deductibles. The latter programs are called “catastrophic” drug benefit plans.
Catastrophic drug benefit plans are becoming increasingly common in Canada, sometime replacing previous comprehensive drug benefits for the elderly. In all provinces that have these drug plans, the government will only subsidize prescription drug costs after a household has spent a certain share of household income on medicines. None of these deductibles are low, but they vary widely across provinces.
A two-adult, median-income household would have to spend nearly $2,000 on prescription drugs in BC before public coverage kicked in; a similar household in Ontario would have to spend over $2,500. It gets worse. A similar household in Manitoba would have to spend about $3,500 before receiving coverage; one in Newfoundland and Labrador would have to spend over $7,000; and one in Nova Scotia would have to spend over $8,000.
Requiring patients to bear such costs for medically necessary prescription drugs is immoral, illogical, and virtually without precedent in comparable countries. That's right. All comparable countries with universal health insurance also provide universal coverage for prescription drugs, without high deductibles. Such universal drug coverage is offered in Australia, France, Germany, the Netherlands, New Zealand, Switzerland, and United Kingdom, just to name a few examples.
It is not just unfair that we charge patients for necessary medicines, it is also inefficient. Studies have routinely shown that when patients must pay for prescriptions, they will use fewer essential medicines as well as fewer non-essential ones. This can drive up costs elsewhere in the system. Indeed, a randomized policy trial in the United States showed that removing all cost-sharing from preventative medicines can be cost neutral to health plans – it increases drug costs because patients adhere to their prescribed treatments more consistently but it reduces costs elsewhere in the system.
Our lack of universal drug coverage also limits our ability to control drug costs. Universal systems of pharmacare have greater buying power and more means of encouraging cost-effective prescribing by health care providers. Don’t believe me? Consider this: according to the OECD, all of the countries mentioned above with universal pharmacare programs spend much less on prescription drugs than Canada does. Indeed, if Canada spent the same amount per capita as these other countries did, we would spend at least $4-billion less per year on medicines than we do today.
Thus, instead of making Canadians with medical needs dig deep into their pockets for prescription drugs, maybe it’s time that we got together to develop a system that was fairer and cheaper for all? That’s why experts from a range of backgrounds are coming together in February to start a national conversation about prescription drug coverage in Canada: Pharmacare 2020 – envisioning Canada’s future in this critically important component of health care.
Steve Morgan is an associate professor at the University of British Columbia. Follow Steve on Twitter @SteveUBC.