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National pharmacare: The devil is (still) in the details

On May 14, Canada 2020 held a forum on pharmacare that gave participants an opportunity to listen to the insights of a wide array of stakeholders with a strong interest in this file, such as insurance companies, patient advocates and senior officials from provincial governments. The event also featured an opening statement from Canada’s Minister of Health, the Honourable Ginette Petitpas Taylor.

As pollster David Coletto pointed out during his presentation, the idea of pharmacare is as close to a national consensus as possible. More than 9 out of 10 Canadians think that people should not suffer because of a lack of coverage, which shows the empathy felt towards the few who are currently uninsured. There are, however, some concerns with regards to the proposed pharmacare initiative, stemming from uncertainty around a potentially costly, one-size-fits-all regime that could reduce existing coverage for some.

Indeed, many stakeholders pointed out the eventual cost of a national regime as a key deterrent. The prospect of investing huge sums in a national system when the current regime has successfully guaranteed coverage for the vast majority of patients is several stakeholders’ top concern. Furthermore, provinces have already successfully implemented dynamic systems where private plans coexist with public coverage for the benefit of all. Finally, questions related to the conception of a national formulary remain unanswered. For instance, will duplicates be avoided, and how will the government ensure key medicines are not wrongly substituted? Panelists and interveners took turns in relaying the idea that a “fill the gaps” approach, where the federal government would work with provinces to extend coverage to those uninsured and target costly medicines, would be the best way to go.

Minister Petitpas Taylor’s speech was much awaited given what is at stake. With the final report of the Advisory Council on the Implementation of National Pharmacare scheduled for release in June 2019 and a federal election slated for October 21, stakeholders were eager to know the specific next steps they should expect to see on this file. Minister Petitpas Taylor took time to manage expectations concerning the timeline leading to a full implementation of the new regime. As she pointed out, the final report of the Advisory Council would merely constitute a first step, upon which the Liberal Party’s election platform will lean.

In the meantime, the government is still looking to address the price of patented medicines, which was mentioned by the Health Minister as crucial to the success of any future pharmacare regime.. Ms. Petitpas Taylor indicated that her government would soon release new regulations framing the prices of patented medicines as set by the Patented Medicine Prices Review Board (PMPRB), with an eye towards making them more affordable. This measure could blend in favourably with a Liberal platform, showcasing progressive bona fides to court left-of-centre voters during the next campaign.

Overall, as speculation remains regarding the shape of a future national pharmacare system, the key will be to make this policy palatable to most Canadians. This entails successfully conveying the empathy felt by most Canadians into a program that provides “pocketbook” value outside of their current plans. While this will not prove easy, the issue will undoubtedly be a subject of interest and debate in the upcoming federal election.