The recent federal election was notable for a number of reasons, including a strong desire for change and the promise of a tight three-way race. But also notable was that PharmaCare — universal prescription drug coverage — made its way into party platforms and in mainstream political debate. PharmaCare has long been the forgotten cousin of the Canadian health care system but 2015 was the year that truly universal drug coverage finally seemed possible.
Too few Canadians have access to medically necessary prescription drugs. Canada is the only country with a universal health care system that does not include prescription drugs. This has created a paradox where Canadians can see their doctor at no cost but many have no ability to purchase the drugs that they are prescribed and that they need for good health. One in 10 Canadians doesn’t take a prescription as directed because of cost.
There are two common misconceptions about prescription drug coverage in Canada. The first is that workers are covered by private plans. Recent research by the Wellesley Institute found that one-third of working Canadians do not have access to employer-provided medical benefits and that people with low earnings are far less likely to be covered than those who are better off. Ninety-four per cent of people earning more than $100,000 have employer-provided coverage compared to only 17 per cent of people earning less than $10,000. Women, young people and part-time workers were less likely to be covered than other Canadians.
The second misconception is that public programs cover people who don’t have private coverage through their employer. In fact, Canada has a patchwork of prescription drug coverage where the level of coverage and what you pay out of pocket depends on where you live, your age, household income, source of income and drug costs relative to household income. This is not only complex and difficult to navigate, it’s also inefficient. Our research found 46 federal, provincial and territorial drug programs in Canada, each with their own administration and bureaucracies. Federal leadership is needed to break through this logjam. We and many other expertsprescribe universal drug coverage as the most equitable and efficient solution to our fragmented system.
The Liberal platform did not commit to universal PharmaCare, but the party did promise to “join with provincial and territorial governments to buy drugs in bulk, reducing the cost Canadian governments pay for these drugs, and making them more affordable for Canadians.” Essentially, the federal government is offering the provinces membership to a bulk buying club to help them to achieve savings. This is not full universal drug coverage but it provides an opportunity to improve access to prescription drugs for Canadians.
The federal government may offer to cost-share elements of provincial drug plans in return for meeting certain access and equity requirements. Now is the time for provinces to think about how their drug plans operate and where they can be improved, including by reinvesting anticipated cost savings from greater bulk purchasing.
Ontario is the largest province in Canada and spent $4.6 billion of prescription drugs for 2.8 million beneficiaries through the Ontario Drug Benefit programs in 2012-13. This covers people on social assistance, seniors and people living in long-term care homes as well as people who had high prescription drug costs relative to their income. Ontario has fairly comprehensive public drug coverage relative to other provinces, butone-third of working Ontarians still have no employer-provided drug plan and have limited access to public coverage.
Fortunately, we don’t have to reinvent the wheel to increase coverage under public plans. Ontario already provides targeted support to children in low income households through the Ontario Child Benefit. The province could expand drug coverage to all children living in households that receive the Ontario Child Benefit or, better yet, to all members of those households. Even better still, we could provide drug coverage to households receiving the Ontario Trillium Benefit, a targeted refundable tax credit available to all low income Ontarians. This approach isn’t specific to Ontario — every province has tax-delivered benefits that target low income Canadians. The basic infrastructure to improve drug coverage is already in place.
Enhancements to provincial drug programs are no substitute for universal coverage and the federal government has a bigger role to play than just helping the provinces to reduce costs, not least by ensuring adequate and equitable drug coverage for every Canadian. But our new federal government has signalled new leadership on the PharmaCare file and provinces need to be ready. This could be a once in a generation opportunity to make prescription drugs more affordable for all Canadians.