Why pharmacare plans keep stalling in Canada even as research suggests billions in savings

While the federal Liberals have pledged to make progress towarda national pharmacare program through a recent deal with the NDP, health care advocates warn those efforts are moving too slowly putting people's health at risk and taking a financial toll on Canada's hospital system.

The government recently announced a "supply-and-confidence" agreement that could see the Liberals stay in power until 2025 in exchange for action on several NDP priorities, including dental care and pharmacare programs.

But there's little to suggest drug access willbe a major focus in the latest federal budget expected on Thursday.

The Liberals intend to pass a Canada Pharmacare Act by the end of 2023, then task the National Drug Agency with developing a national formulary of essential medicines and a bulk purchasing plan by the end of their agreement with the NDP.

It's "concerning" that such an open-ended timeline means building a national pharmacare program likely won't happen until the next election cycle, said Dr. Nav Persaud, Canada research chair in health justice and a staff physician at St. Michael's Hospital in Toronto.

"Multiple reports have detailed how including medicines in our publicly funded system would improve access, improve health, reduce the need for hospitalizations, emergency room visits, and also save billions of dollars both through direct savings, through lowering prices and through the need for health care," he said.

"But much more important than that saved money would be the improved health, and avoided death."

Research suggests billions in annual savings

Back in 2019, a sweeping report on pharmacare from the federal Advisory Council on the Implementation of National Pharmacare, led by Dr. Eric Hoskins, stressed how people's lives can suffer if they skip needed prescription drugs, and noted a Canada-wide program could eventually lead to system-wide savings of nearly $5 billion annually.

Other research from a University of British Columbia and University of Toronto team suggested those savings could be even higher, at more than $7 billion each year.

"Even though many Canadians have some form of coverage, Canada relies on a confusing patchwork of over 100 public prescription drug plans and over 100,000 private plans with a variety of premiums, copayments, deductibles and annual limits," Hoskins wrote in his report.

"For a family or a single patient with a complex condition, those costs can add up to a significant barrier."

Roughly 20 per cent of Canadians have inadequate drug coverage or no coverage at all and must pay out of pocket, he continued.

The Liberals made universal pharmacare a core piece of their election platform in 2019, but by the 2021 campaign, it was barely mentioned by the party.

WATCH | Liberals, NDP strike pact that would keep government in power until 2025:

The Liberal-NDP deal in 60 seconds

2 years ago

Duration 1:00

CBC's Chief Political Correspondent Rosemary Barton breaks down the confidence-and-supply agreement between the federal Liberal and New Democratic Parties.

On the campaign trail that year, NDP leader Jagmeet Singh claimed a federal pharmacare program that would allow Canadians to access drugs with their health card could cost roughly $10 billion, while saving the provinces around $4 billion.

Singh later criticized Justin Trudeau's government after the next budget left out spending to develop the program, with the NDP leader saying the Liberals chose to please "big pharma" over working families.

NDP health critic Don Davies recently told the Canadian Press that he expects the Liberal government will fulfilits renewed promise to deliver national pharmacare but perhaps not all at once.

"You get it started, and then you build on it," Davies said in an interview last month.

Persaud, however, said faster action is needed to make up for previous "broken" promises.

"It's pretty clear that your health card should work at pharmacies just like it works in the emergency room, or when you see your family doctor or before you have to have heart surgery," he said.

"People have to make really tough decisions about rationing their use of insulin or making decisions about paying the rent or buying their medications. And these are decisions that nobody should have to make."

'Near-death experience' without insulin

Ted, a Burnaby, B.C., resident with diabetes, wound up facing that kind of potentially-deadly decision during the pandemic.

In late 2020, the 42-year-old lost his job. As the months passed, finances for his family of five became tight and when his provincial pharmacare access reset in early January this year, Ted realized he faced a deductible of at least $1,500 before his insulin would be covered.

The choice was clear: put food on the table and pay rent, or put that cash toward a medication that helped keep him healthy and alive.

Ted decided to skip his insulin.

The father of three whose identity CBC News is protecting due to stigma around diabetes, and to prevent further trauma to his family felt fine for the first couple of months.

But in March, he began experiencing shortness of breath, chest pains, fatigue, and nausea. One night that month, he vomited at least eight times.

"Come the morning, my family found me on the couch half-conscious, barely catching a breath," he recalled.

Ted's oldest daughter called 911 and her father wound up being rushed to a Vancouver-area hospital where he was diagnosed with diabetic ketoacidosis a life-threatening condition that develops when your body doesn't have enough insulin to allow blood sugar into your cells for use as energy. He wound up spending time in the ER, and several days in intensive care.

"It was a kind of near-death experience," he said.

'Constant battle' to help patients access drugs

Ted is now back on insulin, thanks to assistance from Dr. Tom Elliott, the medical director of advocacy group BC Diabetes, an organization that has been fighting for more support for diabetes patients in B.C. while also backing universal pharmacare.

"I just want to be able to get my patients on the drugs they need, so it's a constant battle every day," Elliott said.

Patients often struggle to afford medication and supplies to manage their diabetes, he said, noting it's a situation that can sometimes lead to people's deaths in just a matter of days while putting financial pressure on hospitals.

In Ted's case, BC Diabetes estimates his brief hospital stay likely cost roughly $25,000 many times the amount of his deductible.

"You can't expect a family of five to be able to pay that much for a life-sustaining drug," Ted said.

"The government has to take serious steps to make changes."

"If you have a medical condition that requires therapy for life, it should be provided by the state," Elliott echoed.

But while advocates maintain a national pharmacare program could offer broad benefits, other organizations have pushed for a slightly different approach.

WATCH | What a proposed dental care plan could include:

What we know about the Liberals proposed dental care program

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The federal Liberals are promising to introduce a dental care program for middle- and low-income Canadian families, under its confidence-and-supply agreement with the NDP. Officials expect the program will start later this year for kids under 12, with full implementation by 2025.

Industry groups back pan-Canada approach

A "pan-Canadian approach to drug coverage" would be more feasible than a national framework, said the Canadian Pharmacists Association in a 2017 paper, which argued it could leverage the existingprovincial/territorial and private sector insurance infrastructure.

Innovative Medicines Canada (IMC), the association representing the country's research-based pharmaceutical industry, announced in March that it welcomes the federal government's renewed commitment to enhancing access to drugs, but also backs a pan-Canada approach.

In a statement, IMC said a pharmacare program should ensure a robust and competitive domestic pharmaceutical industry, and "build on the strengths of our current dual-market system," according to IMC president Pamela Fralick.

Persaud said industry resistance to a universal, national pharmacare program could be part of the reason efforts keep stalling to get one up and running.

"I think one of the main problems with pharmacare is that it would save billions of dollars and that would mean less revenue for pharmaceutical companies and private insurance companies," he said.

"And they lobby hard against these changes."