Groups lobby for national pharmacare

Provincial governments regularly make threatening noises about slashing health care spending. One program that seems to draw the most fire is that ever-controversial seniors’ drug subsidy benefit.

And when it’s open season on drug subsidy programs, a whole lot of seniors get worried. That’s because older Canadians generally use a lot of prescription drugs, and many rely on subsidy programs to help defray their escalating costs.

Without some form of provincial assistance, CARP, Canada’s Association for the 50 Plus, argues that many seniors would be unable to afford prescription fees.

A 1996 study traced the effects of a Quebec policy that increased user fees on prescriptions. It demonstrated that when seniors are asked to dig deeper in their pockets to pay for drugs, they often choose to go without.

The same study showed that this unwillingness to purchase drugs at higher prices brought about a rise in the number of hospitalizations, institutionalizations, and doctor and emergency room visits.

Need pharmacare plan
By calling on politicians to create a national drug plan, CARP hopes these situations can be avoided. its recent brief to Roy Romanow, head of the federal Commission on the Future of Health Care in Canada, CARP called for a national drug program.

“Seniors across the country should have adequate coverage and equal access to prescription drugs,” says Lillian Morgenthau, CARP’s president and founder. “A national pharmacare plan would accomplish this.”

As the role of prescription medication becomes more vital in maintaining our health and wellness, CARP feels it’s a national funding mechanism is long overdue. Latest health figures show that, in 2001, Canadians spent more than $14 billion a year on medication (out of our own pockets or through private or public plans).

To put that figure in perspective, it’s $1 billion more than our national medicare spent last year paying physicians.

Yet medicare doesn’t recognize this role and therefore doesn’t cover the ever-increasing cost of filling a prescription. CARP feels it may be time to rethink this policy.

Provinces supply subsidies
Right now, prescription drugs occupy a peculiar place in Canada’s health care system. Because prescription drugs don’t meet the Canada Health Act’s “medically necessary” definition, medicare will only cover pills when prescribed in hospital.
Provinces, however, understand their importance. They have created subsidy programs to help defray prescription costs for seniors and low-income Canadians who aren’t covered under private insurance or can’t afford the out-of-pocket expense.

Seniors in all 10 provinces and three territories receive some form of coverage, but it’s wildly inconsistent. This has created a very uneven playing field—13 different coverage plans (premiums, co-payments and deductibles based on income) and 13 different lists of what drugs are available under the plan (the provincial formularies).

CARP feels a national program would serve two purposes: all Canadians would pay the same prices for their medications, and everyone would have access to the same drugs.

Next page: Compare Saskatchewan, Newfoundland

Compare Saskatchewan, Newfoundland
To truly understand the gulf that exists between the provinces, compare senior drug subsidy programs in two provinces, Saskatchewan and Newfoundland.

In Saskatchewan:
Residents filling prescriptions often have a co-payment, premium and deductible to contend with.

Senior beneficiaries of the province’s drug plan must fork over a co-payment of 35 per cent of the prescription’s cost. However, those who qualify for the Saskatchewan Assistance Plan, pay only $2 for each prescription.

Plus, there’s a premium of $41 a month for families, $21 for single persons. However, those with low income who do not qualify for social assistance pay lower premiums.

Finally, there’s a deductible, which can be as high as $850 semi-annually.

However, seniors on the Saskatchewan Income Plan or seniors receiving the Guaranteed Income Supplement (GIS) residing in nursing homes pay only a $100 semi-annual deductible.

Senior GIS recipients residing in the community pay more, a $200 semi-annual deductible. It’s a confusing system.

In Newfoundland:
The only seniors eligible for drug coverage are those who receive GIS. They’re required to pay the dispensing fee on the medication.

In fact, senior Newfoundlanders receive less coverage than any other province. And that’s not fair, says CARP.

Harmonize the system
 “We’ve got to come up with some sort of national system that harmonizes this patchwork arrangement, allowing seniors across the country accessibility to same drugs with the same subsidies.” says Morgenthau.

A number of groups besides CARP are pushing this idea, including the Canadian Seniors Congress. This coalition of 12 national groups (including CARP) represents more than two million seniors.

Pharmacists support plan
The Canadian Pharmacists Association (CPA) is another supporter of a national drug plan. 

“The use of medication has become a cornerstone to the delivery of health care,” says Barry Power, director of practice development at the CPA.

“And people should have equitable access to medication regardless of income, age or where they live in the country.”

In a CPA submission to the Romanow enquiry, he pointed out that most European countries currently have fairly extensive national drug subsidy programs.

Next page: What’s the cost?

What’s the cost?
The obvious opposition to such a plan would be its cost.

“Yes, it will be an expensive plan,” says Power, realizing this will be a huge factor in determining if the idea ever gets off the ground.

“But by spending money up front, people can have greater access to medications, and we can avoid a lot of long-term complications and hospitalizations down the line.”

Powers says that the CPA would also like to see the creation of a national formulary where everyone has a minimum access to certain “core medications,” overcoming the accessibility issue.

Until a national plan is in place, the CPA is calling for greater unity among the provinces to iron out some of the differences that exist within their drug subsidy programs. If the provinces fail to work out a plan, the federal government should step in.

It’s far too early to guess at the framework of any national program. That will be determined after much wrangling between politicians and a host of doctors, pharmacists, economists, among others.

CARP sees its immediate role as ensuring that this important idea stays on the health care front burner.