One thing is clear in the debate around pharmacare: Canadians want a pan-Canadian pharmacare program—the question is, what kind?
While there is clear consensus that Canadians overwhelmingly support the “concept” of pharmacare, determining what the program would look like—what Canadians are looking for in such a program—is where the national conversation needs to shift.
Filling over 600 million prescriptions every year, Canadian pharmacists are on the frontline of the pharmacare issue. We understand the issue in practice, not just in theory. Every day we see the indignity that Canadians face when they are not able to afford the drugs they need.
Canadians, too, are clearly concerned about having access to the medications they need to be healthy. However, evidence shows those who have access to an existing private drug plan are quite satisfied. Canadians neither want, nor quite frankly, trust governments to provide better benefits than they are currently receiving under their existing plans.
So the question is, how do we develop a pharmacare plan that builds on the existing private and public plan while at the same time ensures all Canadians have appropriate access to the drugs they need? Furthermore, where do the five principles of the Canada Health Act (universality, portability, public administration, accessibility, comprehensiveness) fit in and defined in the context of pharmacare? And lastly, how do we pay for it and make it not only sustainable, but effective. It can’t be about more drugs, it must be about more effective drug therapy.
It’s on these key issues that Canadian pharmacists are leading the way. Renewed national discussion on pharmacare requires clear evidence for policy makers and a clear national consensus on priorities important to Canadians. The Canadian Pharmacists Association (CPhA) is committed to gathering this evidence and building consensus with its recently launched Pharmacare 2.0 Initiative, a multi-phased policy development process designed to reboot the pharmacare conversation.
From our research thus far, emerging themes illustrate that Canadians want a pharmacare program that is evolutionary not revolutionary, building on, instead of replacing, their current private plan; they want a program that ensures no one is left behind without adequate coverage; and they want a program that offers more than just medications.
It’s not just access to medications that Canadians want; it’s the care that comes with it. It is called pharmacare, after all. Canadians recognize the value of the essential health care services that pharmacists provide. From counselling patients on effective drug use to screening and managing chronic diseases; evidence clearly shows that when pharmacists are involved in care, health outcomes are improved at a lower cost to the health care system. And shouldn’t that be our goal?
The ongoing pharmacare narrative has been, up to now, narrowly focused. It has been about reducing drug prices instead of improving health outcomes—the government perspective—or it has been discussed in ideological terms. In our opinion, such views miss the mark and risk missing opportunities to achieve cost savings in other areas of the health system through improved medication adherence, early detection, chronic disease management and preventative health measures. Governments need to recognize that they aren’t going to be able to improve care and sustainability by focusing on drug costs alone, which only account for 8 per cent of total public health expenditures. It’s the other 92 per cent where a real impact can be made.
To move forward on pharmacare we need to be put the patient at the centre of this national discussion. While being able to afford their medications is first and foremost a fundamental necessity – no one should have to make the choice between buying groceries and filling a prescription – we also need to ensure that we are providing Canadians with better care, better health and better value for their health care dollar.
While a cooperative approach is required by governments, health care provider groups, private payers, patient groups and other stakeholders to reduce the barriers for Canadians to access necessary medications and services, we need to move beyond the question of whether or not Canadians want a pan-Canadian pharmacare program – there is a clear consensus on that – and get on with the job of defining what kind of program will work best.
Carlo Berardi, Chair of the CPhA, is a pharmacist-owner of independent community pharmacies in the Sudbury, ON, area.