Kirsten Patrick is Deputy Editor at CMAJ
Yesterday an open letter addressed to the leaders of Canada’s federal political parties was published calling for a firm commitment to implementing a universal, comprehensive, public pharmacare plan for Canada in election manifestos. I signed this letter, along with my colleague, CMAJ Deputy Editor Matthew Stanbrook, the former federal Minister of Health Dr. Jane Philpott, 537 other physicians, and 700+ more academics and policy experts. Altogether, there are 1282 signatories.
I signed it because, in Dr Philpott’s words, “Universal, single-payer public pharmacare is a smart investment that will ease suffering and save lives. Let’s get it done.“
Our open letter says,
We believe that ensuring universal access to appropriately prescribed, affordably priced, and equitably financed medicines should not be a partisan issue, and that applying the principles of Canadian Medicare to necessary medicines is not a radical idea.
Indeed it is not a radical idea. CMAJ has published on the potential cost-effectiveness of universal pharmacare, on alternative strategies that are unlikely to work and on the mechanisms by which pharmacare might be delivered. The research has been done, meticulously. The peer reviews are in.
Peer-reviewed research indicates that a universal, comprehensive, public pharmacare program would improve access to necessary medicines and significantly reduce financial strains on Canadian households and businesses. Government and academic studies estimate that such a program will reduce total prescription drug spending in Canada by $4 billion to $11 billion per year.
Furthermore, the WHO and the UN have said we need pharmacare in order to have universal health care.
Every high-income country with a universal health care system provides universal coverage of medically necessary prescription drugs – except Canada, that is. In Canada, universal public health insurance effectively ends as soon as a patient receives a prescription to fill.
I am fortunate to have good private drug insurance through my employer. I would have a hard time if I did not because I take medications for chronic conditions. Many families do not enjoy this luxury and are exposed to substantial financial risk as a result. Some people must make a choice between taking necessary medication and feeding their family. To be honest, I’d prefer not to live in a country where such avoidable inequality exists, even if it means my paying a bit more tax. This is why I signed the open letter. And, frankly, closing this gap is long overdue.
Since the 1960s, five separate national commissions have recommended that medically necessary prescription drugs be included in Canada’s universal, public health insurance system. They all recommended such a program because it is the most equitable and affordable way to ensure universal access to necessary medicines in Canada. The latest of such reports – the June 2019 report of the Advisory Council on the Implementation of National Pharmacare – provides sufficient detail to guide implementation over a feasible timeline that begins with federal legislation and investments in 2020. As experts in health care and public policy, we can state unequivocally that national pharmacare does not need to be studied further before proceeding with implementation…The only ingredient missing is the leadership to act.
I question whether the government’s proposal is a serious one. They call for implementation in 2024. That’s two federal elections away. If they were serious this would have been something addressed early in this mandate. At the very least the proposal would be for implementation early in the second mandate.
This is not a new topic. A Royal Commission first recommended one in 1964. That was followed in 1967 and 2002 of a National Forum and second Royal Commission. In February 2003 all provincial and territorial ministers of health as well as Ottawa agreed to the formation of a national drug policy. In 2004 there was the Romanow Commission. In 15 years we have had 15 national studies from different groups endorsing the benefits of a national drug plan.
No one has voiced opposition to a national plan. Yet we don’t have one. If Ottawa was serious about one we would set an aggressive, short timeline for implementation. We have studied this to death. Enough. Act!