National pharmacare: Our analysis of the interim report

In February 2018, the federal government announced in its budget the creation of an Advisory Council on the Implementation of National Pharmacare, which led us to write our White Paper in November 2018 exposing our analysis based on four guiding principles: access, cost stability, public-private mix and efficiency.

On March 6, the Advisory Council published its interim report. In addition to commenting on the consultations conducted since the Council’s inception, the report proposes six core principles and three foundational elements as the building blocks of a national pharmacare program. In our opinion, these principles and elements are commendable and address in large part our clients’ concerns. In summary:

1. Provide access to medication without financial barriers
2. Ensure portable and consistent coverage across all provinces
3. Provide access to a comprehensive drug formulary, which would include drugs for rare diseases
4. Work in partnership with patients and citizens

• These first four elements address our first principle: access. All Canadians should have access to basic drug insurance covering at least all health conditions. The notion of rare diseases is also included, for which we advocate a national plan.

5. Be founded on a strong partnership between the different levels of government
6. Include a pharmaceutical management system, from prescription to delivery

• These last two elements address our principle of efficiency, just like the government’s concern to implement a sustainable and affordable plan for all Canadians. As for cost stability, it could be fostered through a partnership with patients and citizens, and, hopefully, with other payers, such as employers, unions and associations.

The public-private mix principle remains, for which we hope to get more answers when the final report is published.

1. Develop a comprehensive national drug formulary
2. Create a national drug agency
3. Invest in drug data and information technology systems

The Quebec model has featured a comprehensive list of insured medications for more than 20 years, thereby serving as a safety net for the population, an element we advocated for in our white paper. The creation of a national drug agency and robust information technology systems would optimize the efficiency of the Canadian model, an aspect that has not been explored as much in recent discussions.

Complementing this principle of efficiency are drug evaluation, the decision whether to include the medication on the formulary and cost negotiation, thereby promoting cost stability. The report goes even further than the government’s initial discussion, as it proposes directly supporting prescribers and patients/citizens in using their medication and gathering data.

These core principles and foundational elements are a step in the right direction. However, many questions remain:

• How can we address the issue of expensive drugs in the country?
• How can we integrate a public-private mix?
• Would IT systems communicate with private partners instead of remaining isolated? Few details are provided on the collaboration between different stakeholders, such as employers and unions, the pharmaceutical industry, the insurance industry and patient support groups. An open IT system, with access to data, would be beneficial to all and would drive innovation in Canada. Additionally, the expertise developed by provincial governments, insurers and third-party payers would allow the government to capitalize on existing systems.

We welcome the consideration of access and efficiency in this report. However, we must wait for the final report to discover where the principles of cost stability and public-private mix will fit into the government’s proposal.

While our proposal does not disrupt the current ecosystem, it does maintain elements that work well while filling known gaps. We encourage the Council to be cautious with its recommendations that would further affect the structure of national pharmacare.

The Advisory Council’s final report is expected this spring. We will keep you informed of any developments.