Donald Trump's solution to soaring American drug prices is to have other countries, such as Canada, raise their prices.
Ontario has been the site of dueling pharmacare proposals and Canadians are the victors. At the end of April, the opposition NDP promised universal drug coverage for a list of essential medicines. Not to be outdone, the ruling Liberal party announced universal coverage for all drugs on the provincial formulary for youth under 25 years of age. Most health policy experts praised both proposals, myself included.
The Ontario Liberals have just announced a pharmacare plan targeted at youths aged 25 and under which will provide full coverage for a wide range of prescription drugs. This is welcome news, to be sure. But we must ensure that policies enacted today carry forward to the longer-term goal of equitable and cost-effective health care.
Let me start saying that from my "experience," and that's what this article is all about (not expertise), probably most of my visits to doctors and specialists as a patient have been a waste of my time, plus a misuse of all kind of resources depending on where one is living and what kind of insurance one would have.
As Canadians, we are proud of our universal health care system, which provides publicly-funded essential doctor and hospital care based on need and not ability to pay. Unfortunately, our health system falls short when it comes to prescription medication.
Many drugs prescribed to seniors have either not been adequately studied for this age group or have not been formally approved for the conditions they are being prescribed to treat. They are sometimes prescribed without any evidence they are safe and effective for them, and in some cases, even when they are known to present a possible risk (antipsychotics prescribed to older patients with dementia, for example).
Why? Universal drug plans mean national bodies negotiate fairer prices for prescription drugs. The results are dramatic. So, while some critics claim that universal prescription drug insurance is a nice idea, but not affordable - it's very clear that universal prescription drug insurance is actually the key to affordability.
Many believe pharmaceutical companies are repugnant. There were several serious issues that built the foundation of the anti-pharma movement. While not all companies are guilty or equally responsible, many behaved unethically. They didn't always fully disclose research and safety data if it didn't support their product. They attempted to prevent researchers from voicing serious concerns. They created inappropriate relationships with physicians, leaving the impression that doctors were being bought, and sometimes that was true. This had to change.
Hundreds of codeine tablets stolen from the medicine cabinet of an elderly person living alone in a rural community. Hydromorphone tablets being distributed at weddings and high school parties. Fentanyl patches being cut up and sold for a profit on the street. This is the reality of the opioid crisis in Canada today.
The case of 'too much medication' in Canadian seniors is finally starting to be recognized for the serious problem it has become. Seniors are particularly vulnerable to the adverse effects of too many prescription drugs because aging affects their ability to process medications.
In the arms race between germs and medicine, the global community has two complementary strategies at its disposal: First, we can develop new antimicrobials, and secondly, we can slow the emergence of resistant strains through judicious use of current antimicrobials.
The history of research, including research in Canada, shows that very serious harms may be suffered by persons taking part in research. The rules are not perfect, and they continue to be refined when tragedies do occur, but prior review and oversight has proved a powerful corrective to make research safer for human subjects. The problem is that these research protections don't apply to everyone doing research on people in Canada -- and they should.
If Canada is to implement national pharmacare, surely we want to know more about the drugs we'll be paying for. To this end, we must tackle a pre-existing challenge: we must open up the evidence our drug regulator houses concerning drug safety and effectiveness. For decades Health Canada has kept that information confidential at the behest of drug manufacturers. This practice limits the ongoing evaluation of a drug's safety and effectiveness and, in turn, provincial and territorial governments' decision-making about which drugs to pay for, not to mention physicians and patients who make decisions about which drugs to prescribe and take.
Financial barriers to filling necessary prescriptions result in worse health for patients. They also result in increased use of taxpayer-finance hospital and medical care. In other words, they don't save anybody money in the long run.
The glaring gaps in drug coverage for Canadian children are made stranger by the economic dimensions of the issue. Children's health care represents a drop in the ocean of health care budgets -- extending universal drug coverage to children would constitute a small fraction of total pharmaceutical spending.
National drug coverage has long been a priority for the more than one in five Canadian households that can't afford to buy needed prescription medicines. But in spite of decades of calls for a new program, the idea seemed not ready for primetime. The cost of national pharmacare was seen to be too great in a time of low political appetite for new universal benefits. But it turns out that pharmacare isn't a money sucker -- it's a money saver.
What the report, Improving Medicines for Children in Canada confirmed was what pediatricians in the field already know -- that much of the medications given to children in Canada have never been adequately studied or even formally approved for the conditions they are commonly prescribed to treat.
Provinces are clearly voting with their budgets, going slow and low on approvals and coverage of new therapies. Canada is not wrong to be prudent in taking our time to decide how, or if, a new drug needs to be covered -- a precautionary approach is just the smart way to go.
Bigger does not always equal better; sometimes bigger means dumber. Any national pharmacare program would need an absolute firewall to protect it from the inevitable politics of drug coverage, otherwise you'd be left with even more irrational and expensive drug coverage decisions.
Businesses care about the health and well-being of the Canadian workforce. Employees that can afford the medicines as and when prescribed will be healthier, happier, and more productive. In this election year, it is time for Canada's business leaders to call for universal, public pharmacare.