Why Ontario should pioneer the expansion of prescription drug coverage

At a national health policy conference recently, Ontario’s Health Minister Deb Matthews made a few notable comments. Among them was a request that policy experts applaud government officials when they do the right thing. Too often, good healthcare policy gets blocked by a very vocal minority of stakeholders.

Minister Matthews also said that expanding prescription drug coverage would be a top priority for Ontario if the government had the money to do so. This is great news because my colleagues and I released a CD Howe Institute report on how to improve pharmacare in Canada on the same day she made those comments.

Our report contains praise for Ontario. Ontario’s system of prescription drug financing performs as well as or better than any other provincial system in Canada.

But before celebrating that point too much, the report also shows that all of Canada’s provincial pharmacare models have significant flaws not found in other countries with comparable healthcare systems.

Every other country in the world with a universal healthcare system also provides universal coverage of prescription drugs — at little or no cost to patients. In doing so, they achieve better access to necessary medicines, better financial protection for patients, and far lower total expenditures on medicines than any Canadian province does, including Ontario.

The good news for Ontario is that Minister Matthews’s proposal to expand public coverage for medicines makes sense both for improved healthcare (by way of better access to needed drugs) and for Ontario’s financial bottom line.

It is regarding the financial bottom line that Minister Matthews may have been given the wrong impression — perhaps by interests who oppose what is good healthcare policy concerning prescription drugs.

There is no need to delay the implementation of expanded drug coverage until the money is available. There is already more than enough money in Ontario for this.

The employers, unions, patients and tax payers of Ontario are already footing a very large bill for prescription drugs — larger than any comparable healthcare system in the world. But, because drugs are financed through a patchwork of private and public payers, Ontario is not achieving the purchasing power that comparable systems worldwide achieve.

To paint a clearer picture: if per capita spending on medicines in Ontario was the same level as it is in the United Kingdom, the people of Ontario would save nearly $6-billion every year. That is enough money to hire 16,000 more physicians, which would be a 65% increase in the supply of doctors in Ontario.

The government of Ontario has already shown leadership on pharmaceutical policy in recent years. It was the leader in efforts to reign in excessive prices for generic drugs in Canada. That was a tough-fought policy change that has generated hundreds of millions in savings for Ontario and elsewhere in Canada.

Ontario has also shown leadership by assisting other provinces in price negotiations with brand-name manufacturers. This not only helped smaller provinces in difficult negotiations, it also increases Ontario’s negotiating power.

I hope that Ontario will continue to provide leadership by expanding prescription drug coverage in Canada.

The route forward is not to create “an open bar” for medicines in Ontario. Rather, the Ontario government should focus on providing universal coverage for medicines of proven value to the healthcare system.

The public drug program in Ontario could, for example, be expanded to provide universal access to essential drugs to treat cardiovascular disease, diabetes, asthma or mental health. If done right, Ontario would secure far more competitive prices for covered medicines, improve access to essential healthcare, and reduce unnecessary demands elsewhere in the system.

Political insiders might notice that such a policy is consistent with a proposal that Kathleen Wynne included in her Ontario Liberal Leadership platform. I’d say it’s time to act. Together, Premier Wynne and Health Minister Matthews could be pioneers of the biggest, most important healthcare reform of a generation.

This editorial is reprinted with the permission of EvidenceNetwork.ca.

The comments section is closed.

  • HealthQuotes.ca says:

    Agree with this article. There is also the issue of generic substitution and best cost equivalency, where it can be tough to get name brand drugs. Now doctor’s have to give a detailed explanation as to why a generic drug cannot be used.

    Guess it does outline the cost disparities regarding the manufacturing of pharmaceutical drugs!

  • Laurie Fowler says:

    Thank you for your article. We are currently trying to get access for the first and only drug for IPF (idiopathic Pulmonary Fibrosis). Our ministry has denied based on the CADTH CDEC panel of 13 people, non versed in IPF, as well the manufacturer data was reviewed by (whomever does that at CADTH) and key evidence was not submitted. My mother is one of many that has no hope at life without this drug. Many other countries are covering for their constituents. It was listed on Health Canada’s Registry of Innovative New Drugs. Private health insurance is covering (government employees included). So if you have private health care or are wealthy you have access. If you are a senior on a pension, Deb Matthews will allow you to suffocate to death without the aid of Esbriet. She has told ne it would be considered illegal for her to intervene! The Health Care Act says otherwise. I would ask all to look up CADTH and really delve into this entity. Our taxpayer dollars are funding this flawed corporation. Oh did I mention employees receive in house massage on our buck? CADTH is not how I want decisions impacting my life to be determined!

  • Laurie Fowler says:

    Sorry to disagree, I am currently fighting for a drug for my senior mother. The flaws and bias I have found are astronomical. I have had many conversations with D. Matthews and have support from MPP’s and still our Ministry will not fund. The frug she needs is Esbriet which was given priority review by health Canada and is on their list of innovative new drus. They have compared IPF as being as lethal as many cancers. If you investigate CADTH you will find our system very flawed and most questionable. As far as funding more drugs, this is not happening, look at the CADTH drug list. Mental health, pain and rare diseases always receive recommendations not to list. But if you look at HIV/AIDS 20 drugs were submitted, 17 were recommended for listing, now if you look at the panel that reviews drugs you will find that two of the members have direct relation to HIV/AIDS, I think it would be fair to assume preferential treatment based on personal reasoning. CADTH is just another example of unnecessary spending of taxpayer dollars, to redo what health canada is ver good at in evaluating drugs/technologies.

  • Tap Off says:

    “…proven value to the health care system.” That is not a very detailed explanation of your assessment.
    I believe it should be a system of up to date (state of the art) proven value to the health and well being of all Canadian and Ontario citizens.
    This would of course include a National strategy with people on review boards who have health policy and socially based health economics, and clinical and social epidemiologic expertise who assist in setting policy. Some of those review board members may not be physicians…..

    Dear Steve Morgan, Have you actually experienced the current drug program institutional behaviour in Ontario?
    Yes, it is time to act in a valid socially responsible manner to assure the funds go to assisting citizens who are not employed somehow by the institutional machines that now exist. Working within government to minimize corporate interests and assuring properly trained, efficient, empathetic critically thinking people are employed to work for those citizens who depend daily on decisions made by the policies and actions of the administrators and ‘evaluators’.

    Hiring more physicians is a good diversion of funds. But streamlining the primary care practise politics and policy is also an excellent way to improve care beyond the drug coverage policies.

  • Hans says:

    I think that investing the $6 billion potential savings in community care, long term care, improved medication compliance etc. would be a much wiser use of these funds than hiring 16,000 more MDs. Overall the provinces need to find alternative integrated ways to deliver care not hire more doctors.


Steve Morgan


Steve Morgan is an associate professor at the University of British Columbia.

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