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http://irpp.org/

@irpp

Welcome to Fireside Chat # 438

February 27, 2015 1:00 2:30 PM Eastern Time (Teleconference open for participants at 12:50 ET)

Is Canada ready for a national

pharmacare program?

Moderator:

Graham Fox (IRPP)

Panellists:

Steven G. Morgan (University of British Columbia)

Steven Lewis (Simon Fraser University)

www.chnet-works.ca

Canadian Health Human Resources Network University of Ottawa

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Moderator:

Graham Fox has been president and CEO of the IRPP since April 2011. He brings to the organization a decade of executive-level experience in the fields of politics and public policy. Previously he was a strategic policy adviser at the law firm of Fraser Milner Casgrain, and before that he was vice-president of the Public Policy Forum, executive director of the KTA Centre for Collaborative Government, and director of communications at the IRPP.

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Panellists:

Steven G. Morgan is a professor in the School of Population and Public Health at the University of British Columbia and an expert in pharmaceutical policy. He leads the Pharmaceutical Policy Research Collaboration and is the founder of Pharmacare 2020, a campaign to promote evidence-informed conversation about the future of prescription drug coverage in Canada.

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Steven Lewis is a health policy and research consultant

based in Saskatoon and adjunct

professor of health policy at

Simon Fraser University.

Prior to resuming a full time

consulting practice he headed a

health research granting agency

and spent seven years as CEO

of the Health Services Utilization

and Research Commission in

Saskatchewan.

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Yes

No

Unsure / Undecided

Should Canadian medicare include

prescription drugs?

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Incentives for pharmaceutical innovation and investment

Access to necessary prescription drugs for all Canadians

Equity in the distribution of pharmaceutical costs

Efficiency in management of pharmaceutical expenditures

Appropriateness of prescribing and medicine use

Which of these is the most important

goal for a pharmacare plan?

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22 Appropriateness

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24 Equity

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26 Economy

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Which of these is the biggest barrier to

national pharmacare?

Lack of a clear policy vision

Limited public engagement

High cost of program

Opposition from interests

Federal-Provincial relations

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Should Canadian medicare include

prescription drugs?

Yes

No

Unsure / Undecided

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Universal Pharmacare is Essential. National, Perhaps.

Federal, Not So Much.

IRPP Webinar February 27, 2015

Steven Lewis, President Access Consulting Ltd., Saskatoon Adjunct Professor of Health Policy

Simon Fraser University

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Where We Agree

Drugs are no less essential than hospitals or doctors

Canada should be ashamed of its performance in terms of Coverage Equity Quality of prescribing Cost-effectiveness

The Morgan case for universal coverage, price reductions, and quality improvement is ironclad

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National Doesnt Have to Mean Federal

In theory the provinces could formally band together to

Negotiate drug purchases

Develop strategies for introducing and evaluating new drugs

Align most of their formularies

They would retain responsibility for pharmacare but act in concert, collaborative rather than compete, and share

intelligence

This could create a de facto national program without needing Ottawas guidance, blessing, or money

That would certainly with the Oscar for Best Original Screenplay!

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Why The Provinces Wont Do It

Different political priorities some governments would be opposed in principle

Different starting points some have better coverage than others and the additional costs would vary

Wary of being bound by collective decisions about new drugs and composition of formularies

The 2 largest provinces are in big fiscal trouble (and so is AB now)

The 2 largest provinces are home to most of Canadian pharma R&D

No history of achieving national without federal skin in game

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Why Ottawa Wont Do It

No current appetite for investing in nation-building or adding major new social programs

While sector is a mess, serious financial barriers affect relatively small proportion of population no burning platform

Reluctant to make the ironclad, long term guarantees for cost-sharing and escalated transfers that would get provinces to go along

Legitimate case for investing elsewhere (e.g., spend the $25 billion/year to eliminate poverty)

Federal-provincial relations not warm (First Ministers dont even meet anymore)

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How Attractive Is It Politically?

The politically powerful classes already have either 3rd party drug coverage or the means to pay out-of-pocket

Businesses might like it because it would (could) absolve them of responsibility for covering employees

Private insurers would oppose if it drove them out of business

Concern about spending even higher % of provincial and federal budgets on health care

If tied to tax increases, predictable widespread opposition

Conundrum: the benefits (health, financial, quality, equity) would be quite invisible to most people

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Houston, We Have A Game Theory Problem

It is in the public interest to have comprehensive, universal, high quality pharmacare

In the end, the public pays for drugs and bears the consequences of our pharmaceutical policy and practice failures

The interests of governments and political parties as institutions do not always coincide with the public interest based on a rationalist world-view

Individual citizens may be unaware of the inefficiency of the status quo and may disbelieve the prospects for improvement

What makes sense for all (rationally) may make no sense to any (psychologically and politically)

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But Even If The Stars Were Aligned, Should Ottawa Do It?

Drugs should be fully integrated with other elements of health care

Keeping the provinces fully in charge of the whole spectrum of services is the best hope for integration

Privileging drugs over other health care options would be an unhappy side effect if Ottawa owned pharmacare

Federal investments big enough to get the provinces to go along may simply perpetuate the high prices and bad practices that plague pharmacotherapy (remember the Health Accords)

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So Are We Stuck With Nihilism?

Morgan has identified useful federal roles:

Policy on IP (generics) and pricing

Intelligence multiple strategies to improve prescribing

Research and evaluation

Making the system a lot smarter can generate the dividends that would make a universal program more attractive and affordable

Even here, there will be blood:

Changing policy will evoke reaction from pharma

Smarter prescribing will mean fewer sales of many drugs

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