What’s Next for Pharmacare?

Pharmacare was a major issue in the recent federal election, and the re-elected Liberal government has promised to implement national pharmacare, a legislative priority in a minority Parliament on which the New Democratic Party of Jagmeet Singh has concurred. The Liberals have endorsed the principles laid out in the report of the Advisory Council on the Implementation of National Pharmacare delivered last June, and set aside money in their fiscal framework for a “down payment” while they negotiate with the provinces on how to implement the system. How is that likely to work? Before the Bell assembled a panel of experts and stakeholders to discuss the current landscape.

Ihor Korbabicz, executive director of Abacus Data, said that during the election campaign, 18 percent of Canadians polled stated that they were driven by trying to reduce out-of-pocket health costs like pharmaceuticals, and that 92 percent of Canadians polled said that nobody should suffer because they can’t afford medicines that they need. As well, 78 percent of those polled felt that pharmacare was an area where the Liberal government and the NDP could work together in the new parliament.

During the Pulse segment of Before the Bell, with special guest co-host Derick FageJennifer Stewart, president and founder of Syntax Strategicsaid that pharmacare was likely to be a priority for the government after Prime Minister Justin Trudeau’s adoption of the Hoskins report.

“It will be very difficult in terms of how you implement this, how do you work with the provinces, how do you get the premiers on board that don’t necessarily have the best relationship with Trudeau right now?” said Stewart. “Not an easy path forward, but definitely a priority.”

Rachel Curran, principal with Harper and Associates, said that while the country can afford it, the question was whether it was the best use of $15 billion.

“That’s going to be the discussion with provinces and territories because they have to deliver healthcare — they are constitutionally responsible for this,” said Curran. “If they push back at all, it’s going to be around how they have other pressing needs and looking at models that fill the gap, that provide support or coverage to Canadians who are under-insured and uninsured, and the estimates for those are between eleven percent and twenty percent of the population.”

The Pulse on Before the Bell. From left to right: Special guest co-host Derick Fage, Rachel Curran with Harper and Associates, Peter Cleary with Santis Health and Jennifer Stewart with Syntax Strategic.

Peter Cleary, senior consultant with Santis Health, said that there is a real discussion happening among bureaucrats across Canada because drugs for rare diseases are the number one growth item for drug budgets across the country.

“It’s unsustainable, and nobody has a good answer for it right now,” said Cleary. “There are actual questions that will be driving the conversation behind the scenes, that will be happening while we have a fun show of health ministers meeting.”

During the Policy segment of the event, with host and Before the Bell president Andrew BeattieDr. Seema Nagpal, vice president of science and policy with Diabetes Canada, said that having a national formulary to ensure equal but limited access to drugs across the country is not what the government should be aiming for, but that the goal should be broader access to a range of drugs.

“Patients are requiring medications across different disease groups, and require devices and supplies — in the case of diabetes, to test their blood sugar and to monitor their condition over time,” said Nagpal. “These are things that need to be included in the discussion about a formulary that defines what is covered by a pharmacare system.”

Nagpal also said that having a patient-centred policy and bringing patients into the discussion from the beginning is important to show that governments value their opinion.

Joelle Walker, vice president of public affairs for the Canadian Pharmacists Association, said that pharmacists do a lot of the background work with drug plan management. Because implementing a pharmacare program will be tricky, patients and healthcare providers should be included in the discussion.

“Developing a national formulary can be very difficult because we’re talking about not just what is clinically effective, but what are provinces willing to pay for things, and you have to make very difficult choices,” said Walker. “Health providers and pharmacists can provide the clinical expertise, but developing a national formulary is going to take a lot of time.”

The Policy panel on Before the Bell. Pictured from left to right, Host Andrew Beattie, Dr. Jennifer Shulman with KPMG, Jody Cox with Canadian Generic Pharmaceutical Association and Biosimilars Canada, Joelle Walker with the Canadian Pharmacists Association and Dr. Seema Nagpal with Diabetes Canada.

Jody Cox, vice president of federal and international affairs with the Canadian Generic Pharmaceutical Association, and vice president of Biosimilars Canada, said that generic drugs currently fill about 73 percent of all prescriptions in Canada, and account for about 20 percent of the total expenditure on prescriptions, yet the use of generics in Canada is lower than in comparable jurisdictions.

“There’s a role in the new Canadian Drug Agency for the promotion of cost-saving alternative medicines, and that was clearly outlined in the Hoskins report,” said Cox. “If you’re just going to pay for products that have been on the market for twenty, thirty or forty years and continue to pay high prices for those products, then you won’t be able to afford innovative new therapies. That’s the value proposition for both generic and biosimilar medicines.”

Dr. Jennifer Shulman, partner with KPMG LLP, said that the Hoskins report specifically recommends the idea of covering 50 percent of currently prescribed medications as part of the first phase of the national pharmacare plan.

“Figuring out what that 50 percent is, is going to be challenging,” said Shulman. “They point to the price to the patient of the drug, as well as the clinical effectiveness of the drug itself. This notion of value for money is going to be quite critical. How that’s specifically going to be defined is still uncertain, and which drugs will fall on the initial formulary.”

Shulman said that supply will be a critical component of pharmacare, especially if Americans start coming north to take advantage of cheaper prices.

Watch the full edition of Before the Bell here:

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