Still no national drug program after 15 years of hearings, studies and agreements

One of the universal areas of agreement in Canada is the benefit of a national pharmaceutical program.

Everyone agrees a national pharmaceutical program would save money through bulk purchases of drugs. Canada has the second highest drug costs in the western world. If we had a bulk purchasing program we could use the weight of our buying power to reduce costs and it would ensure we avoided shortages of certain drugs, which have and do happen. It would also be a benefit to pharmaceutical companies because it would help them adjust their sales efforts, production and distribution so they could make more money on lower per product prices.

No one disagrees this is a good idea. In fact, in February 2003 all of Canada’s health ministers – federal, territorial and federal – agreed to a national drug policy. It was part of the foundation for the 2004 Health Accord. A national drug policy was such a good idea the health ministers agreed two more times to institute it.

A royal commission first recommended this in 1964. In 1967 and 2002 there were a national forum and another royal commission. Then, in 2003 it looked like we might act. But we didn’t. Why?

Governments agreed to it 15 years ago. No one has spoken against it, yet successive governments of all political stripes have failed to institute one.

The idea is so popular that it’s virtually spurred an industry producing annual or semi-annual schemes for a national policy.

In 2004 in support of the new National Health Accord the Romanow Commission studied it.

In June 2006 a Federal/Provincial/Territorial Ministerial Task Force on the National Pharmaceuticals Strategy said, “…Prescription drugs also constitute the fastest growing and second largest category of health care expenditure in Canada. Like governments around the world, Canada is faced with the challenge of optimizing the benefits of prescription drugs for Canadians while managing the risks and complexities associated with this rapidly evolving sector.”

“After hospital care, Canada spends more on drugs than any other major category of the health care system. Since 2000, the total public and private expenditure on prescription drugs has grown by approximately 12 per cent annually. This rapid escalation in drug costs threatens the sustainability of public drug programs.

“To ensure that Canadians continue to benefit from robust public drug coverage, public dollars must be used efficiently. By collaborating on drug price and purchasing issues, Canada’s public drug plans can encourage greater competition, increase transparency and reduce market fragmentation to ensure Canadians get the best possible prices for pharmaceuticals.”

Two of that report’s nine recommendations were:

— Establish a common National Drug Formulary for participating jurisdictions based on safety and cost effectiveness;

— Pursue purchasing strategies to obtain best prices for Canadians for drugs and vaccines;

More information is here: https://www.theglobeandmail.com/news/national/with-universal-drug-coverage-canadians-could-save-billions-study/article34141670/

In February 2017 a study in the Canadian Medical Association Journal said if the government provided universal coverage for 117 essential medicines, which accounted for 44 per cent of the prescriptions filled in Canada we would save nearly $4.3-billion.

In June 2017 a paper A Better Prescription: Advice for a National Strategy on Pharmaceutical Policy in Canada said, “Canada needs a national strategy to fulfill its obligation to ensure universal access to necessary healthcare, including prescription drugs. A 2004 attempt at a national strategy for pharmaceutical policy failed because it lacked clear vision, logical planning and commitment from federal and provincial governments. The result of uncoordinated pharmaceutical policies in Canada has been more than a decade of poor system performance.”

The Better Prescription paper, found here: http://www.longwoods.com/content/25160 says “Since 2010, provinces have been voluntarily collaborating on prescription drug pricing through a Pan-Canadian Pharmaceutical Alliance; and some provinces, most notably Ontario, have been calling for federal-provincial collaboration to establish a universal pharmacare program to make medicines more accessible to all Canadians. At the federal level, the Liberals’ 2015 election platform included promises to negotiate a new health accord and to work to make prescription drugs more affordable in Canada, promises that ended up in the new health minister’s mandate letter after the Liberals formed government in late 2015. Perhaps not surprisingly then, in January 2016, when the federal, provincial and territorial health ministers met for the first time in many years, they created a working group to explore pharmaceutical policies aimed at reducing prices, at improving prescribing and the appropriate use of drugs, and at improving coverage and access to medicines for Canadians.”

This paper tells us that in 2016 Canadians spent $30 billion on prescription drugs and $5 billion of the private spending was wasted! Further, it says that over $400 million is spent on unnecessary drugs for people over 65 and estimated that “one in six hospitalizations in Canada could be prevented if prescription drugs were prescribed and used more appropriately.“

Another paper, National Pharmacare in Canada: 2019 or bust? https://www.policyschool.ca/wp-content/uploads/2017/03/National-Pharmacare-Adams-Smith.pdf begins by saying, “It is the Canadian public policy issue that rears its head with regularity, never achieving much more than discussion, and yet never going away entirely. The issue is pharmacare, and once again it is back for discussion among academics and policy-makers, and once again it looks like the discussions will not go anywhere anytime soon. The proposal for a publicly funded pharmaceutical- coverage plan is frequently on the table in Canada, but it still is not in the cards.”

A second February 2017 paper, the Estimated effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada http://www.cmaj.ca/content/189/8/E295 “could address most of Canadians’ pharmaceutical needs and save up” to $5.83 billion annually if we covered 117 of the most prescribed drugs.

From 2006 to 2017 we have had study after study, paper and presentation after another on the benefits of universal drug coverage. Here are links to a few:

https://open.library.ubc.ca/cIRcle/collections/ubccommunityandpartnerspublicati/52387/items/1.0048260

https://www.ourcommons.ca/Content/Committee/421/HESA/Brief/BR8289787/br-external/CanadianNursesAssociation-e.pdf

http://www.pdci.ca/wp-content/uploads/2016/01/Pharmacare-Preliminary-Report-PDCI-January-2016.pdf

https://www.collectionscanada.gc.ca/eppp-archive/100/201/300/cdn_medical_association/cmaj/vol-162/issue-4/0523.htm

https://dspace.library.uvic.ca/bitstream/handle/1828/8612/Derksen_Cameron_MPA_2017.pdf?sequence=1

https://www.cma.ca/Assets/assets-library/document/en/advocacy/PD10-02-e.pdf

http://www.aims.ca/site/media/aims/Final%20-%20The%20Effectiveness%20of%20the%20Common%20Drug%20Review%20in%20Canada%27s%20National%20Drug%20Strategy.pdf

https://nursesunions.ca/wp-content/uploads/2017/07/universal-pharmacare-report-e.pdf

In 15 years we have produced at least 15 major studies on the benefits of a national drug policy. We have studied this topic to death. The benefits to people, patients and the system are clearly identified. The money to relieve the stress on the health care system is in the savings. In Nova Scotia’s case this 15 years of inaction has cost us in excess of $805 million in over-payments for prescriptions. That’s roughly half the projected cost of a replacement VG. What more do politicians, health ministers and governments need before they act?

 

 

 

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6 Responses to Still no national drug program after 15 years of hearings, studies and agreements

  1. billybob1963 says:

    1. Missing a word last sentence, third paragraph.
    2. To make the kind of savings possible it is not just as simple as ensuring “PUBLIC dollars must be used efficiently.” We can only get the kind of purchasing power, access and equity by ensuring ALL spending is used efficiently. Private insurance is just one of the many culprits in our system. But we are throwing good money after bad by continuing to subsidize – heavily – a sector that is the only one that offers absolutely no value-added for the health system or economy.

    • What word? I’ve re-read that and it makes sense to me. That’s the problem with our own mistakes, we make them because we don’t see them.

    • As to your second point about public dollars – true, but politicians are even less motivated to institute a policy that saves the private sector money. Public money is the headline that will eventually harness the private sector spending.

  2. Bubbie says:

    Big guns like Amazon, J.P. Morgan, and Warren Buffet have announced they are considering a partnership with a plan for a self-insured medical plan for their employees cutting out third-party insurers along with administrators and high-level managers. According to this report, this announcement has contributed to the recent plunge in the stock markets.

    It is not hard to see after reading this report on the planned partnerships of the leading economic powerhouses of Amazon, J.P. Morgan, and Warren Buffet, P3 partnerships do not work and contribute greatly to overall costs.

    It is my thought we will never see this kind of partnership between the government and Big Pharma because the drug companies are in the back pockets of politicians contributing to their bottom line.

    https://www.vox.com/technology/2018/1/31/16950500/amazon-health-care-jp-morgan-chase-warren-buffett

    • You say the VOX report makes it clear that P3 partnerships don’t work and contribute to costs. What Buffet, Amazon and Morgan propose is not a P3 partnership. P3 stands for public private partnership. This is a private venture, which isn’t seeking public funds. It is harnessing the ideas and buying power of two of the greatest business minds in world history, so that’s going to be disruptive. Is there a chance they could fail? Yes. But they have histories of shaking up conventional thought and processes to do something in a better way. And in America, health care can’t get much more expensive. The people who are aghast and against whatever plan this threesome come up with have a vested interest in the status quo. And the status quo hasn’t shown itself beneficial for patients.

      Today I had an email exchange with a man whose wife is undergoing cancer treatments. He can’t believe of the inefficiencies, problems and uneven level of care with the delivery of health in Canada. The whole health care system in both countries can stand for more disruptors. The status quo is hurting and harming people.

  3. Bubbie says:

    I believe my comment was misunderstood. I am familiar with what P3 means. What I was trying to illustrate was while Buffet, Amazon, and J.P Morgan are banding together to cut out the middleman, instead of controlling the costs by partnering with all of the provinces and farming out some of the distribution to companies like BlueCross Medevie, the Federal Government continues to allow the fragmentation of pharmaceutical costs by allowing costs to be negotiated separately between provinces.

    We no longer have a national health care plan as each province decided to go it alone with the Federal Government and as a result, Nova Scotia will lose a billion dollars in transfer payments over the next years. McNeil sold out for twenty-five dollars for every man, woman, and child in this province, over the next ten years. Like Buffet, Amazon, and J.P. Morgan, the Government should control cost in a very similar way.

    I agree with what these three economic powerhouses are planning to do.

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