Experts question if Canada’s pharmacare plan is the best approach for all Canadians

Industry leaders say a targeted approach to fill pharmaceutical coverage gaps would be more efficient than spending billions to provide coverage to everyone

Experts question if Canada’s pharmacare plan is the best approach for all Canadians
Gary Walters, chief actuary, GroupHEALTH Benefit Solutions, Carolyne Eagan, principal spokesperson, Smart Health Benefits Coalition, and president, Benefits Alliance

The federal government has finally released details about its universal pharmacare plan and, while most people agree this is good news for people that are not covered by drug plans, some industry leaders are not convinced a universal pharmacare plan is the most efficient way to ensure the best pharmaceutical coverage for all Canadians.  

On Thursday, the federal government introduced legislation for the first phase of its national universal pharmacare plan. Bill C-64, An Act respecting pharmacare (Pharmacare Act), which proposes the foundational principles for first phase of national universal pharmacare in Canada and describes the Government of Canada’s intent to work with provinces and territories (PTs) to provide universal, single-payer coverage for a number of contraception and diabetes medications. 

The government says this legislation is an important step forward to improve health equity, affordability, and outcomes and has the potential of long-term savings to the health care system. 

In its initial stages, the pharmacare plan will start with coverage for contraception and the medicines and supplies needed to manage diabetes. In addition, the pharmacare framework legislation lays the foundation so that in the future, the plan can cover all medically necessary pharmaceutical products for all Canadians. 

Most people would agree that this announcement is great news for Canadians, especially those who are not insured or underinsured. However, not everyone agrees a universal pharmacare plan is the most effective approach.  

Why cover all to help a few? 

Industry leaders are questioning why the government would use $1.5 billion (an estimate given by Mark Holland, minister of Health, for the cost of the program) to provide pharmaceutical coverage to the entire population when only a fraction of the population needs coverage. 

The government should have taken a less wasteful approach, says Gary Walters, chief actuary with GroupHEALTH Benefit Solutions and a member of Health Canada's implementation advisory group for drugs for rare diseases. He says $1.5 billion is a lot of money to pay for coverage that only less than a quarter of the population needs.  

“We know the majority of Canadians do have the coverage they need. So, why are we spending over $1 billion dollars on people who don’t need the coverage? We could use that money to cover other things that people do need, like drugs for rare diseases. There are people who need coverage and [a pharmacare plan] is good news from that point of view. I just think there’s a more efficient way of doing it.” 

Walters says a wraparound product, which wraps around current coverage and fills the gaps, might have been a better approach rather than wholesale replacement. “The gaps are absolutely there. But, if the gaps are less than 25 percent, why pay for the other 75 percent? Do taxpayers want to pay for something that is already covered?” 

The Smart Health Benefits Coalition (SHBC), a collective force dedicated to transforming healthcare in Canada, believes that action to meet the challenges of access and affordability for those Canadians without adequate and affordable drug coverage would be faster, more impactful, and a lower cost if the government prioritized filling gaps in coverage and helping uninsured or underinsured Canadians with their out-of-pocket expenses. “Considering that nearly four out of five Canadians have quality drug coverage, the Pharmacare Act, as proposed, is disappointing,” the organization said in a press release.  

Filling in the gaps a better approach 

“SHBC believes that a targeted approach of spending money to fill the gaps is a better approach for getting relief and protection to Canadians who are struggling to afford medications,” says Carolyne Eagan, principal spokesperson for the Smart Health Benefits Coalition and president of Benefits Alliance, an SHBC member. “No question it is extremely valuable to help Canadians who are either uninsured or underinsured to afford to buy birth control and diabetes medications, like other essential medicines. But why dedicate taxpayer money to fund medications that are already substantially paid for through employer sponsored benefit plans or existing provincial health systems that cover the vast majority of people?  The money saved could be allocated to further help those who are uninsured or underinsured by covering the gap for other essential medicines too. 

“In addition, funding solutions could also be allocated to where the pain points exist for the most impacted Canadian families, specifically to help fund or partially fund out-of-pocket expenses for high-cost drugs and drugs for rare disease. This is a very real challenge that is putting pressure on our health care system, employers, and most importantly on families directly, regardless of whether someone has coverage through a public plan or through an employer benefits plan.   

“We believe that a smart and targeted solution that addresses challenges in our health care system coast to coast is best focussed on leveraging what we have and taking fast, concrete action to fill gaps in more areas, faster. SHBC believes this is a path that can help Canadians not only today, but in a long-term sustainable fashion.” 

Walters agrees that it would be much more efficient to use the funds allocated to the universal pharmacare plan to help fill the gaps in care. “Let’s help the people who need it instead of ‘helping’ people that already have it.”