opinion: canada needs a universal pharmacare program that doesn't leave anyone behind
for pharmacare to be successful, federal, provincial and territorial governments must work together to address the barriers that prevent people from accessing medications from public reimbursement plans.
3 minute read
according to health canada, three million canadians have reported not filling their prescriptions because they could not afford the cost.
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in the 2022 budget, the federal government committed to tabling the canada pharmacare act by the end of march 2024, including the development of a national formulary of essential medicines by the canadian drug agency, with the goal of helping the millions of canadians without access to prescription medications or sufficient prescription drug coverage. however, in order to succeed and provide more comprehensive prescription drug coverage for people in canada, federal, provincial and territorial governments must work together to address the barriers that prevent people from accessing medications from public reimbursement plans — plans they are theoretically entitled to.
co-payments, premiums and deductibles can make medicine unaffordable
provinces and territories determine not only the drugs to be reimbursed in their jurisdiction, but also the conditions under which people can access them. these conditions often include co-payments, premiums and deductibles — money that has to be paid out-of-pocket by the person needing the medications. for people with low to modest incomes, this can make many medicines unaffordable. in fact, one in five canadians struggle to pay for prescription drugs. this means that a person’s employment, age, income and province of residence can determine their prescription drug access based on their ability or inability to contribute to public reimbursement coverage.
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these inequities in access can have serious consequences. for example, some people delay, skip or cut doses of prescribed medicines in half to make them last longer. others cut back on food and heating costs in order to be able to afford their medication, while others simply don’t fill needed prescriptions. (according to health canada, three million canadians have reported not filling their prescriptions because they could not afford the cost.) none of these options is acceptable. imagine skipping or delaying medications for chronic diseases such as diabetes: the consequences can be catastrophic, leading to hospitalization or even death.
take-home cancer medications: sometimes paid for, sometimes not
inequities in drug access also exist in the area of cancer treatments. most provinces pay for take-home cancer treatments, while a few do not. for example, two patients with the same type of cancer in a province that does not cover oral cancer treatments could have vastly different out-of-pocket expenses if one is offered an intravenous drug in hospital (which is covered), and the other receives a prescription for a take-home oral medication (that has to be paid for).
and while most jurisdictions have implemented catastrophic drug coverage for those not able to access public plans and who face high out-of-pocket prescription drug expenses in relation to their income, the annual deductibles required — often a percentage of household net income — can still render the prescription unaffordable.
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government partnerships can reduce inequities and increase drug access
to eliminate barriers, federal, provincial and territorial governments must co-operate to find solutions and be willing to fund them adequately. the federal government’s recent $35-million agreement with prince edward island, for example, which will help the province lower co-payments for certain medications under its provincial drug plan, reduce the deductible for its catastrophic drug program, and expand the number of drugs covered under its public health plan shows how governments can work together to reduce inequities in access.
we need more partnerships like this.
provincial and territorial governments must also work together to harmonize the medications that are covered under their public health plans — a national formulary may well help with this — and close the gaps in coverage between medications taken in hospital versus those taken at home. to successfully reform drug coverage, it’s essential that governments consult with relevant stakeholders, including those with lived experience, those who serve them, and experts in health equity who understand the problems and have solutions. by working together, we can build a strong universal pharmacare program that does not leave anyone behind.
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after all, everyone deserves access to lifesaving medications regardless of where they live and how much they earn.
louise binder is the health policy consultant for save your skin foundation.
dr. naheed dosani is a palliative care physician and health justice activist.
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