A universal pharmacare program can help remove inequities in access to drugs based on age, income and geography, and achieve savings in the overall cost of pharmaceuticals.
The 2018 federal budget included a promise to create an Advisory Council on the Implementation of National Pharmacare. Essentially, pharmacare would mean Canadians would have the costs of drugs and medications covered under our public health insurance system.
Is Ottawa’s announcement what pharmacare advocates have been waiting for? Maybe.
Some of the early details give reason for optimism, while others raise concerns.
My research shows that to understand current reform efforts, we need to learn from our history. Specifically, we should take lessons from past attempts to expand public health insurance in Canada. Doing so can help us understand the obstacles facing the new advisory council as well as opportunities for it to achieve real change.
One concern is that the new council will amount to “just another study.” There have been a number of federally sponsored studies of pharmacare in the past, from the 1943 Heagerty Committee to the current parliamentary standing committee on health that has been studying the development of a national pharmacare plan since December 2015 and is due to issue its final report shortly.
Some observers have been encouraged by the word “implementation” in the new advisory council’s name. But there are certainly many details that will need to be worked out if pharmacare is to be implemented on a national scale.
A concrete step to ensuring success would be to give the council the mandate and resources to focus on a detailed implementation plan, rather than revisiting yet again whether Canada actually needs expanded public pharmaceutical insurance.
Another concern is that the council will be too timid, focusing its attention on “patching up” existing drug insurance programs rather than planning for the major overhaul many experts believe is necessary.
Incremental change may seem attractive, but my research has found that this approach limits opportunities for achieving meaningful expansions in public health insurance.
Since the earliest days of Canadian health policy development, many politicians and top bureaucrats have viewed pharmacare as fundamentally unaffordable. This idea has persisted despite evidence to the contrary, and it makes them reluctant to consider bold reforms.
However, when it comes to expanding public health insurance, the research shows that incremental approaches do not tend to culminate in significant change. Instead, incremental reforms that are intended to expand coverage step-by-step stall because they require resources but do not deliver on important reform objectives, like improved equity and access and better cost control.
Finance Minister Bill Morneau hinted the day after the budget was tabled that the advisory council was being steered towards constrained reform. He told the Economic Club of Canada that he anticipated a pharmacare strategy that “deals with the gaps, but doesn’t throw out the system that we currently have.”
Key pharmacare advocate on board
There has been only one example of a major expansion in Canadian health insurance since public hospital insurance was first introduced: Nationwide medical insurance in 1968. However, this required federal-provincial cooperation, an attentive public pressing for change and significant political will from then-prime minister Lester B. Pearson.
A promising sign of political will is the choice of Eric Hoskins to chair the council. Hoskins has been a longtime advocate of national pharmacare.
He presided over the 2017 expansion of Ontario public drug programs to cover children and youth up to age 25, and he left his position as Ontario’s minister of health in order to helm the new council.
The budget calls for the council to learn from “domestic and international models” of pharmaceutical insurance, but lessons from our own experience should not be ignored.
Understanding the successes of other pharmacare programs will be helpful, but successful implementation will depend on understanding and addressing the barriers faced by past attempts at reform here in Canada, particularly the erroneous but entrenched idea that pharmacare is fundamentally unaffordable.
Keeping the pressure on
Everyone can contribute to making the advisory council a success and a national pharmacare program a reality.
Experts need to clearly communicate the evidence about how good pharmacare systems work and how much they cost.
The public needs to evaluate that evidence against their own values regarding public health care, and keep the pressure on their leaders for results.
The advisory council needs to be careful in its analysis of the evidence and bold in its recommendations.
Finally, politicians need to have the courage to seize this once-in-a-generation opportunity to make a real difference to the health of Canadians.