In June 2019, the Advisory Council on the Implementation of National Pharmacare released their report concerning the recommendations on the implementation of a national pharmacare program. The final report recommends the establishment of a universal, single-payer, public system of prescription drug coverage in Canada.
They propose that the five fundamental principles of medicare be applied to national pharmacare:
- Universal: all Canadian residents should have equal access to a pharmacare system.
- Comprehensive: pharmacare should provide a broad range of safe, effective, evidence-based treatments.
- Accessible: access to prescription drugs should be based on medical need, not ability to pay.
- Portable: pharmacare benefits should be portable across provinces and territories when people travel or move.
- Public: the national pharmacare system should be publicly funded and administered.
The Council’s goal was to examine pharmacare models in place internationally, and use them as a guide for a national pharmacare plan in Canada. They heard from patients, practitioners, employers, government officials, First Nations, Inuit, and Métis people.
CCSN was also able to provide valuable input to the Council with the submission of a brief (see below), and was formally heard during the Advisory Council’s consultation process.
To offer a bit of background, Canadians spend more on drugs than they do on doctors, and drugs are the second biggest expenditure in healthcare, only beat out by hospitals. Canada is the only country in the world with universal healthcare that does not provide universal coverage for prescription drugs. One in five Canadians struggles to pay for their prescription medicines, and millions don’t fill their prescriptions because they can’t afford to.
The current system relies on a confusing and fragmented process involving government drug insurance program and thousands of private drug insurance plans. The result is a non-system, where too many people are liable to fall through the cracks. There are significant gaps in coverage, and these gaps are more likely to affect women, young people, and those with low incomes. In addition to this, the current system involves unsustainable drug costs, especially with new drugs coming onto the market.
As mentioned above, the Council recommends a national pharmacare plan that works like medicare – a universal, single-payer, public pharmacare. This will involve collaboration between the federal government and provincial and territorial governments, as well as stakeholders.
However, they recognize that this program cannot be implemented overnight, and will thus be put into place following a stepwise approach. This will involve the creation of a drug agency, which will create a list of essential medicines representing about half of all prescriptions, and make this initial list of drugs available through national pharmacare beginning January 1, 2022. The full, comprehensive national formulary would be in place no later than January 1, 2027.
They also propose to have low copayments that do not pose a barrier to access, as well as the development of a strategy to improve access to expensive drugs for rare diseases.