The news last week that the federal government may include part of the cost of prescription drugs in the spring budget suggests Prime Minister Justin Trudeau may be planning to campaign on a narrow form of “pharmacare” during the 2019 federal election.
The best evidence-based model for pharmacare in Canada, one that’s been advocated by hundreds of academics and policy experts, is that of a single national payer (the government) operating according to a national formulary (a list of drugs that meet the priority health needs of the public), with limited or no up-front patient charges.
Sounds great, right? Unfortunately, not to everybody.
The monetary redistribution from such a program inevitably makes this a political issue where certain stakeholders have much to lose. If you are healthy and wealthy, work in the private health insurance industry, work for a pharmaceutical company or are, like us, community pharmacists, you may not necessarily come out ahead financially.
Why are these particular groups negatively affected?
Well, if you are healthy and wealthy, you may take fewer drugs and pay more taxes to subsidize the drug costs of sicker people.
If you work in private insurance, the creation of a national plan will threaten the value of the product you offer, driving down beneficiary enrolment.
If you work for a drug manufacturer, the increased purchasing power of an organized national collective would drive negotiated drug prices down, reducing your company’s profit margins.
Lastly, if you’re a pharmacist, it is unclear exactly how professional fees would be affected by policy changes. Given the negative impacts of generic drug price reform and provincial policy responses on community pharmacy businesses, it is unlikely that the popular, evidence-based model of universal pharmacare would be a win.
In spite of all of this, as community pharmacists we still support evidence-based, universal pharmacare, and we’re not simply virtue signalling either.
Pharmacare means better patient care
Those working in community pharmacy, and the patients who visit us, share in the frustration of coordinating different coverage policies between payers, dealing with suspended drug coverage and trying to keep abreast of changing criteria and billing procedures.
This is all done by insurers in their competitive attempts to cost-shift to one another in order to limit their own prescription claim expenses. Sick individuals have to be sure to fax this form here, watch for this letter in the mail and get their doctor to sign this form first.
The administrative, mental burden for pharmacists (and prescribers) to memorize variable eligibility criteria, explain coverage issues to patients and to follow the proper order of operations to secure correct payment is draining. And that is not even to mention the audits!
Though this has long been a daily reality we have become used to, it still deprives us of time spent in our health-care role. Universal pharmacare, while it wouldn’t eliminate this burden entirely, would surely make the working lives of pharmacists and other health professionals easier by freeing up our time from dealing with insurance plan issues to focus more on patient care.
Nonetheless, beyond the cost savings and increased workplace efficiency, there will be economic losers as we move to finally bring pharmaceuticals into our socialized medicare model. The real people working in this part of the health-care sector, many of whom are working, middle-class citizens, should not be subject to undue fiscal penalty simply from benefiting from the previous status-quo.
After all, not only would they lose revenue, but they would also pay increased taxes to add insult to injury. Unlike everyone else, these people would be getting squeezed from both sides.
A tax break for industry employees?
Perhaps the fairest thing would be to grant tax breaks or exemptions for those working in affected businesses or industries (not simply the healthy and wealthy).
This seems feasible based on a recent study in the Canadian Medical Association Journal that estimated that the additional financing required for universal pharmacare could be accomplished by an approximate one per cent increase in personal income tax of the nearly 30 million tax-paying Canadians.
Exempting around 150,000 private insurance employees, 30,000 pharmaceutical industry employees and 50,000 pharmacists and pharmacy technicians from standard taxation may be a small consolation for lost business revenue.
We would hazard a guess that the approximately remaining 29.5 million tax-paying Canadians can afford to make up the difference.