Des questions en suspens sur le régime national d’assurance-médicaments

On March 6, the Advisory Council on the Implementation of National Pharmacare released an interim report that shed some light on what could be the building blocks of Canada’s national pharmacare program, but also left a lot of questions pending.

Since the launch of the Advisory Council in June 2018, Chair Dr. Eric Hoskins and the Council have conducted an eight-month consultation process with thousands of Canadians including patients, government, pharmacists, pharmacy owners, clinicians, representatives from the insurance and pharmaceutical sectors, Indigenous organizations and leaders, healthcare providers, organized labor groups, employers and academics.

Identifying the three major challenges facing Canada with respect to prescription drug coverage as affordability, inconsistency and sustainability, the report states that there was “broad agreement that national pharmacare should provide comprehensive, evidence-based drug coverage in a fair, responsible and sustainable manner,” and highlighted three foundational elements that will underpin any national pharmacare program:

1. Create a national drug agency

2. Develop a comprehensive, evidence-based national formulary accessible to all Canadians

3. Invest in drug data and information technology systems that cover the entire spectrum of care

The mandate of a new national agency would be to perform health technology assessments of prescription drugs, negotiate with manufacturers, and develop and implement the national formulary that would harmonize drug coverage across the country. It is unclear at this stage what role, if any, the federal, provincial and territorial drug programs will play in the development of a national formulary, and if Quebec will be part of the national drug agency or keep its health technology assessment agency (INESSS) and own drug coverage formulary. The interim report does not provide details on the proposed pharmacare model, but the Council plans to recommend a single model for prescription drug coverage in their final report.

It is expected that the federal budget to be released on March 19 will continue to add context and details on the proposed program. Dr. Hoskins stated that the final report from the Council will be released sometime between late-March and mid-June 2019, four months ahead of the looming federal election. The government is now tasked with the delicate challenge of designing a program that enhances Canadians’ access to prescription drugs at an affordable cost that won’t turn tax payers off.

Few people would dispute that the timing of this interim report announcement was an attempt at channel-changing away from some of the major issues plaguing the Government. Canadians and industry alike are still waiting on details of the potential program, particularly whether the Liberals will offer up a comprehensive universal national program for all, or a program that looks to fill gaps in coverage within vulnerable populations. Questions remain on what the potential drug formulary would cover, and where issues like treatments for rare diseases fit into the picture.

From an implementation perspective, it also remains to be seen how the Government of Canada intends to create a national pharmacare program while tending to the delicate sensitivities of federal-provincial areas of jurisdiction. This concern should be top-of-mind for the Prime Minister and his government given the fact that most provincial legislatures are controlled by conservative-minded parties with little desire to give Prime Minister Trudeau a progressive win. Coupled with the fact that the majority of healthcare is funded and administered locally, the Prime Minister will have to tread lightly in order to get what he wants.

As we discussed last year, regardless of the pharmacare model, the end product should not reduce existing access to treatments and should inspire innovative companies to continue research and development efforts in Canada. In parallel, another file to monitor is the federal government’s announcement that it plans to move forward with the proposed PMPRB reform to modernize the drug pricing rules. We will continue to watch for the outcomes of the PMPRB review which will also have impact on our life science industry in Canada.