Can an essential medicines list fix drug coverage gaps?

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  • Aurelia Cotta says:

    Micheal Kalin is exactly right. Strattera is considered a “last option” drug for ADHD by experts. See for the practice guidelines.

    Bupropion is a critical adjunct med for many who take SSRIs to stop metabolic syndrome side effects like weight gain, and sexual side effects. (Many people quit antidepressants due to those 2 side effects)

    And no calcium? You may want to chat with your nephrology department. No clonidine? Cardiology and Endocrinology would like to weight in on that, thanks.

    Gravol for nausea by the way, is far far safer than one that is on your list. Metoclopromide is a major inhibitor of dopamine receptors, and degrades them severely. Which is why Health Canada has a black box warning labelling it an incredibly dangerous drug for anyone with Depression, Anxiety and especially ADHD. I note that your list doesn’t even asterisk the meds with black box warnings, or major side effects. Is that even legal? (Answer: No)

  • Cynthia Leung says:

    I agree with establishing an essential list of medicines. But the list alone is not sufficient. We are already experiencing drug shortages of essential medicines.

    At a federal level, policies must be implemented to ensure supply and production decisions of these essential medicines cannot be made unilaterally by the pharmaceutical industry. The government must take measures to ensure there will always be an adequate supply of essential medicines available to Canadians.

  • Michael Kalin says:

    “The proposed essential medicines list for Canada is intended to provide universal public coverage of essential medicines and result in significant cost savings through bulk buying and single payer negotiations.”

    Among the medications missing: Bupropion, Calcium, Clonidine, Gravol, Plaquenil, and any SNRI.
    Medications that confuse: Strattera as the only treatment for ADHD. Eletripan for migraines. Keflex as the only Cephalosporin.

    Don’t worry – Viagara, Testosterone and Propecia made the list. What about Rogaine?

  • Wendy Ungar says:

    While an essential drug list and national core formulary is useful in countries with centralized health care systems and a single publicly subsidized drug plan, it would be difficult to implement in Canada where there is high inter-provincial variation in eligibility for public drug plans as well as the medicines covered. The main criterion for listing on the proposed list is being “common” but prescription prevalence is not synonymous with need. Many of the proposed drugs are inexpensive and easily available now through existing private or public plans for 85% of the population. Moreover, such a list would not serve vulnerable populations well, e.g. children, whose disease burden is less than that of adults. The claim that such a list would generate savings is dubious — it would simply shift the payer. Even if drug prices could be lowered through bulk purchasing, it is likely that prices would increase for other drugs not on the list to maintain revenues for private insurers. It would be more beneficial to target a national plan to those currently ill served by existing public and private drug plans. Fore more information, see:

    • Merrilee Fullerton says:

      Excellent and thoughtful post.
      The unintended consequences must be considered.

  • Linda Wilhelm says:

    History has shown that payers are often reluctant to pay for many medicines that can drastically improve and save patients lives. Would an essential medicines list then make it more difficult for us to access a necessary drug because it’s not identified as “essential” by a bureaucrat with little to no knowledge of the disease the drug treats? If having such a list would free up more dollars so that patients can more easily access a medication that their physician has decided is necessary that would be good but usually cost savings in health go back into the big black hole of the system never to be seen again.

  • Chris Bonnett says:

    An essential drug list could improve access for some Canadians. It should lead to greater equity among those covered by provincial drug plans. In time, it may save some money.

    However, we should first identify the problem are we are trying to solve. If we have bigger drug access, affordability and equity issues, an essential drug list is a blunt instrument and may not be the most important tactic. For example, how many of the 8% to 10% of Canadians without enough insurance will be better off? How will it help those with financially catastrophic expenses, or trying to access rare drugs? They are the ones who need help now, not those with insurance. My concern is that if we focus governments on this single narrow program idea, everything else will stop and we will be no closer to achieving a universal drug program that is equitable and sustainable.

    Two other thoughts. We need to be really cautious about relying on models that project billions in savings, apparently overnight. (“Essentially, all models are wrong, but some are useful.”) Second, we need to consider the practical in addition to the theoretical – how are we going to manage the crucial role played by employers and insurers? National policy and program development must include those who contribute nearly half the spending and cover over half the population. A patient consultation is also needed.

    The bigger picture is getting universal coverage. While single payer may be the most efficient, social insurance with minimum coverage standards and appropriate regulation is likely more practical. In either case, a more comprehensive drug policy is needed before we lurch to this idea or any other. Another patch is not necessarily progress.


Karen Palmer


Karen is the Destination Development and Marketing Coordinator at The Corporation of the County of Prince Edward.

Mike Tierney


Mike is the Vice President of Clinical Programs at Ottawa Hospital.

Joshua Tepper


Joshua Tepper is a family physician and the President and Chief Executive Officer of North York General Hospital. He is also a member of the Healthy Debate editorial board.

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