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)

http://irpp.org/
Panellists:

@irpp

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.

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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Should Canadian medicare include

prescription drugs?

Yes
No
Unsure / Undecided

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Which of these is the most important

goal for a pharmacare plan?

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

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Appropriateness

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Equity

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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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