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National Pharmacare: To Be Or Not To Be

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Today's disjointed pharmaceutical policy may be described as a Shakespearean tragedy -- a flawed system that will always end with demise.

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Health Ministers meet in Toronto this month to discuss Canada's health care policies

The relationship between health care policies, the funding of prescription drugs and public access to medically necessary medication is fragmented. It is in need of political leadership. With the provincial, territorial and federal health ministers meeting in Toronto this month, the time has come to discuss the details of a National Prescription Drug Strategy. How are we going to move this forward?

Global Public Affairs' recent report "National Pharmacare: Lost in Translation" outlined the players on the stage and how their competing interests, affects Canadian's access to prescription medications.

The public values their health and improvement to their quality of life. Employers seek increased productivity associated with healthy employees. Governments want improved population health, individual satisfaction, and health system sustainability (triple-aim). The pharmaceutical industry wants market access for products that are valued by patients and payers alike to generate returns and to support ongoing and future research.
Private insurance providers aim to minimize the number of clients on long-term disability and prevent the emergence or recurrence of health problems. And health professionals want to cure illness and reduce suffering.

These goals and desires are not mutually exclusive and yet our current system fails to meet many Canadian's expectations. Understandably so -- it is, after all, everyone for themselves.

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Doctors, the public, the government, and employers each have competing interests when it comes to pharmacare.

The current system operates without common goals. Each player plays their role to the best of their ability and to their best advantage. But as there are no directors, not all actors are treated fairly and equitably.

How is this problematic? The result is a tragedy. There is inequitable, unpredictable access to effective, necessary prescription medicines. There's a reason why this is happening.

Today's prescription medicines are a key tool to restore and maintain health. When prescribed and taken appropriately they reduce other health system costs, help individuals avoid hospitalization and support Canadians to function effectively in their daily lives. Prescription medications help treat and cure patients with acute illnesses and delay progression for those with chronic diseases.

Canadians spend approximately $29 billion annually on prescription medications. After hospitals, it is the second largest component of health care spending, exceeding the spend on physician services. This spend occurs outside of the principles of the Canada Health Act, and too often at arms-length from the rest of the health system.

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Little data is available on how medication is used in physician visits or hospitalizations.

There is limited and inconsistent integration of medication use data with physician visits, hospitalizations, or care planning. The result is a poor understanding of the impact that pharmaceuticals have on patient outcomes or the value they offer to the health care system.

It's fair to argue that all Canadians want equitable access to effective medications without incurring financial hardship. Yet, increasingly, access is compromised due to ability to pay, employment status, clinical condition or disease, age, ethnic heritage or even one's postal code.

There is an overall lack of accountability -- no one accepts responsibility for the overall health system or where access to prescription medication fits in. With individuals and groups acting in isolation, access to necessary medications may be rationed or denied.

So, how do we focus on a common goal when there are disparate and competing interests operating in a complex, imperfect system?

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Political leaders must step up to make sure prescription medications are available for all Canadians.

Due to the dominant position public payers have in funding prescription medications in Canada, strong, principled political leadership is required to ensure the system delivers consistent value for all Canadians.

Federal Health Minister Jane Philpott, who has responsibility for Health Canada, the agency that approves medicines for sale in Canada, has a role in balancing access to existing and new medicines while ensuring patient safety. The federal government also has the ability to rebalance tax credits and insured health benefits to reposition the $29 Billion in annual spend. Through shifts, Ottawa could make more direct dollars available to the provinces for consistent, national access to appropriately prescribed drugs, including both valued existing products and new innovative medicines.

Though the creation of the pan-Canadian Pharmaceutical Alliance, and their existing drug plans, Provincial Ministers of Health now have additional tools to improve access to medications and create greater value for Canadians. Their focus should include more timely and predictable assessments, access and funding when a product's value has been demonstrated. They should also build greater accountability for appropriate use. They must continue to seek ways to increase efficiency, measure value and measure outcomes that result from better integration of medications with other components of the health system.

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All levels of government must work with Canadians to ensure better access to pharmaceuticals across the country.

Finally, both levels of government need to work smarter and more cooperatively. Granted this will take time, but industry, physicians, pharmacists, employers and patients can't start doing the heavy lifting without direction from the federal and provincial health ministers.

Canadians must work together to address our fatal flaw.

Steve Long is a Senior Associate, Health and Life Sciences, at Global Public Affairs. A pharmacist and former Executive Director, Pharmaceutical Funding and Guidance at Alberta Health, Long principally focuses on health policy development, including pharmacy regulation, health technology assessment (HTA), and product reimbursement.

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