Progress towards more efficient and accessible drug plans risks stalling by strict agendas that fail to recognize the issue’s complexities.
By Åke Blomqvist and Colin Busby
Progress towards more efficient and accessible drug plans risks stalling by strict agendas that fail to recognize the issue’s complexities. The oft-mentioned plan for universal coverage under Ottawa’s mandate is a case in point. A more realistic plan would immediately improve drug coverage for the most at-risk populations and aim to achieve universality over time by dealing with the issue of high prices and quality prescribing.
We agree with Steve Morgan, and many others, that the degree of drug coverage in Canada is inadequate, that the way in which we pay for drugs is inefficient and inequitable, and that a national bulk purchaser is an important solution going forward. But we disagree on how to accomplish these goals and instead believe that incremental progress towards them is the best, and most likely, way forward.
The Liberal Party of Canada was elected on a platform to engage the provinces in the bulk purchasing of drugs and improve access to necessary medicines. We think both planks – bulk purchasing and better access – are laudable. But we also think that the new federal government should aim higher.
And as we aim to ensure that no one in any province, no matter its size, fails to fill a prescription because of lack of financial means, one must pay close attention to the additional burden that such an initiative would put on government budgets.
The trouble with proposals for the immediate introduction of a universal pharmacare plan under which governments would pay essentially all drug costs is that the immediate impact would be large increases in government spending, to the tune of over 10 billion dollars. To politicians at the provincial level, this will seem like a risky gamble.
We also don’t think it is a good idea for the federal government to unilaterally create and pay for a universal pharmacare plan. The feds are not directly responsible for paying most other healthcare costs, such as those for hospitals and doctors, and good policy requires integration in the management of overall health costs.
We propose instead that Ottawa transfer additional funds to provinces with existing or new programs that respect minimal conditions. This would mean:
- Having all provinces improve coverage for Canadians who fall through the cracks of private and provincial plans, which means raising the level of coverage in provincial catastrophic plans;
- Improving access by collecting patient charges at tax time, not when filling a prescription;
- Forming a single purchaser for all drugs in Canada;
- Working with provinces on creating a national list of covered drugs (formulary);
- Working with provinces to improve the quality of prescribing.
This should not be misinterpreted as imposing one drug model on all provinces – all provincial plans that cover seniors and social assistance recipients could continue. Rather, the focus would be an immediate improvement in the backstop “safety net” coverage for populations most vulnerable to avoiding filling a prescription due to cost. Plus, deferring collection of any patient charges until income tax time would help in reducing access problems for people who are covered by these plans.
And to be fiscally responsible, this initiative could be paid for with the phasing out of non-taxation of employer-based health and dental benefits, which costs the federal treasury over $2 billion annually.
Universal coverage should be what we are working towards – but it is unlikely to be the starting point.
When there are complex policy debates, as there is for prescription drugs, smart policymaking should consider many points of view, including Steve Morgan’s. At the C.D. Howe Institute, we take the importance of open dialogue seriously, because the wrong decisions could have major consequences.
Åke Blomqvist is an Adjunct Research Professor at Carleton University and Health Policy Scholar at the C.D. Howe Institute, where Colin Busby is a Senior Policy Analyst.
Published in Troy Media
