National Pharmacare: Expanded Drug Access or Lowest Common Denominator?
Aldo Del Col, Co-founder of
Myeloma Canada
Last winter, the House of Commons’ Standing Committee on Health recommended that Canada create a universal national pharmacare program to expand public health insurance from primary care and hospitals to include prescription drugs outside of hospitals.

Presently, Canada’s health care system covers visits to the doctor and medically necessary hospital care. Once someone goes to fill a prescription, universal public health insurance ends for many Canadians. Pharmacare or universal health care aims to fill the gaps to improve access to prescription drugs.

Prescription drugs are essential to overall patient care, so ensuring universal drug coverage is a worthy and necessary goal. But beware—depending on the final plan that emerges, millions of Canadians might potentially have less coverage than they presently enjoy. 
Or, if a more enlightened approach is taken, pharmacare could transform our currently inequitable patchwork of drug coverage to ensure that all Canadians have access to the prescription drugs they need. In other words, we need to be demanding a national pharmacare program that improves drug coverage rather than limits it. It boils down to the politically-expedient “lowest common denominator” approach versus a more ambitious and equitable “expanded drug access” aspiration. Myeloma Canada supports the latter option, putting patients ahead of politics.
According to a study published by the Canadian Health Policy Institute in 2016, almost 23.2 million people were covered by a private drug plan, while the remaining 13.1 million people were covered under public drug plans. Given that the total population of Canada was nearly 36.3 million, the study suggests that virtually all Canadians are covered by either a private or a public drug plan. In reality, the number of drugs covered under different plans varies considerably. 

Ontario’s public formulary, for example, covers less than 5,000 drugs, whereas some private drug plan formularies cover more than 10,000 drugs. Additionally, access to many high-cost oncology drugs in public plans is either non-existent or very restrictive. According to the Parliamentary Budget Office, there are 700,000 people with no drug coverage, and an estimated 3.6 million with inadequate coverage. For the Canadian Health Policy Institute to state that virtually all Canadians are covered by a drug plan is naive and misleading.
Although pharmacare is understood to mean a system of public insurance for drug coverage, there are several interpretations of what such a program could look like. Alternative proposals include:
  • A national pharmacare program run by the provinces under national standards with one formulary
  • One pan-Canadian, single-payer pharmacare program run by the federal government
  • A mixed public-private model

Each option has its supporters and detractors. Divergent viewpoints and agendas, combined with the perennial tug-of-war between the federal and provincial and territorial governments regarding constitutional powers over health, risks compromising the the scope and mandate of the program, to the detriment of patients.
The rationale for a national pharmacare is anchored in cost reduction. The Office of the Parliamentary Budget Officer report suggests such a program would lead to huge cost savings of perhaps $4-billion a year. As taxpayers, we should all welcome initiatives that improve the cost-effectiveness of publicly-funded programs. Those purported savings would come from joint buying, more strictly regulating drug prices, more aggressive use of generics, and limiting the formulary (the list of drugs that are covered.)

But as patients, we should be more concerned about whether or not a national pharmacare formulary will include the expensive, life-saving drugs we need. As many of you know, Health Canada approved 4 myeloma drugs in 2016: Kyprolis® (carfilzomib), Darzalex® (daratumumab), Ninlaro® (ixazomib) and Empliciti® (elotuzumab). Two years later, only carfilzomib has been approved for funding, and only in the following provinces: British Columbia, Alberta, Manitoba, Ontario and Quebec. A patient-focused national pharmacare program would ensure that all Canadians, irrespective of where they live, have equal access.
The central question is which drugs will get listed on a “national formulary”. In other words, how expansive will public drug coverage be in terms of what gets covered? If cost reduction is the driving consideration, then there is a serious risk that millions of Canadians will have their current drug coverage reduced. That is why we need to keep the decision makers focused on the needs of the patient by expanding drug coverage, not limiting it.

The Advisory Council on the Implementation of National Pharmacare (ACINP) has been tasked with a “mandate to study, evaluate and ultimately recommend options on a path forward on pharmacare.” 

In June, the ACINP, chaired by former Ontario Minister of Health and Long-Term Care, Dr. Eric Hoskins, kicked off a public consultation with the release of a discussion paper . The Council will travel across Canada to meet with healthcare experts, patients, interested stakeholders, and provincial, territorial, and Indigenous leaders.

What is Myeloma Canada doing?

Our Executive Director, Martine Elias, working with policy leaders from a number of Canadian patient support groups is leading the charge by working with the ACINP office to ensure that as many patient groups and patients representing a large swath of Canadians is represented at the consultation meetings that are about to begin across the country. Martine will be attending the first consultation meeting in Toronto on July 18 th . Many myeloma patients have been invited to take part in other Canadian cities over the summer and early fall. If you are interested in being part of these consultations, please contact Martine at melias@myeloma.ca.
Aldo Del Col
Co-founder
Myeloma Canada