According to the Wellesley Institute, Canada is the only developed country with a universal healthcare programme which does not include access to prescription drugs. Thus, while Canadians don’t need to pay to see their doctor, prescription drugs are not covered by the universal healthcare programme. And they are some of the highest priced in the world, with patients’ out-of-pocket expenditure on prescribed drugs amounting to $3.6bn annually.
Big pharmaceutical corporations make huge profits from the marketization of prescription drugs. And they have great policy influence on the federal and provincial governments. The National Union of Public and Government Employees (NUPGE) observed that “for large insurance companies or drug manufacturers, the current situation is very profitable. They would prefer not to see a national pharmacare programme.”
Similarly, Linda Silas, CFNU president said, “big pharma and the insurance industry profit from our current system, and Canadians don’t trust them to look out for our interests or think they should influence our public health care policy”.
The costs of this overbearing influence of big pharma is not only in dollars and cents. It includes the loss of lives and has adverse impact on people’s wellbeing. An expert research report commissioned by Canada’s nurses last year found that at least 640 people die prematurely every year from one disease alone because of unaffordable medications. It also documented the avoidable deterioration of the health status of some 70,000 older Canadians annually due to the high cost of medications.
A national poll commissioned by the Canadian Federation of Nurses Unions (CFNU) and conducted by Environics Research between 9 and 21 January reveals that Canadians want universal pharmacare. This was stated in a media release issued by CFNU on 19 February.
The poll confirmed that:
- 88% agree it is better to have a simple cost-effective prescription drug coverage program that covers everyone in the country than the existing patchwork programme.
- 85% agree that it is worth investing public money for prescription drug coverage.
- 84% think that prescription drugs should be included in our public health care system.
Lack of universal access to prescription medications has increasingly undermined the benefits of Canada’s universal healthcare programme. In an article published in the Canadian Medical Association Journal in 2012, Michael R. Law et al showed a 10% cost-related nonadherence to prescription, in the population.
By 2015, members of almost one in four families were not adhering to prescriptions because they could not afford the price of medication, according to a national poll. An additional 36% of Canadians responded that pharmaceutical expenditures were causing them financial hardship. 91% of respondents declared support for a national pharmacare programme that would ensure universal access.
CFNU organised an issue-based campaign to place healthcare issues at the front burner of debates during the 2015 elections; #Vote4Care. The campaign called for expanding medicare into new areas, including pharmacare. Public concern on the need for a national pharmacare programme which puts people over profit heightened after the elections.
For over a year, the federal health committee heard from more than 100 experts after which it called for the expansion of the Canadian Health Act (CHA) to include pharmacare in April 2018. Two months later, Prime Minister Justin Trudeau constituted a seven-member national advisory council led by Dr Eric Hoskins, former Ontario health minister, to come up with a national pharmacare strategy.
In September, more than 70 national, provincial and territorial organisations, including NUPGE and CFNU came up with the best model for national pharmacare, as part of the policy formulation process, national dialogue initiated with the constitution of the advisory council.
This is based on Consensus Principles for National Pharmacare, which has now been adopted by over 80 organisations, viz:
- Public, Single-Payer Administration
- Portable Coverage
These principles constitute the backbone of the 28 September 2018 submissions of CFNU and the Health Sciences Association of British Columbia/NUPGE to the Advisory Council on the Implementation of National Pharmacare. The submissions stressed the need for Canada’s national pharmacare to be “governed by a public authority on a non-profit basis to ensure accountability exclusively to the public interest and democratic institutions”.
The final report of the advisory council will be released in June 2019. However, an interim report was issued at the beginning of March. While presenting the report, Dr Hoskins said "the current system of prescription drug coverage in Canada is inadequate, unsustainable and leaves too many Canadians behind". His council has called for the establishment of a national drug agency to address the issue.
The interim report fails to address a universal, single-payer pharmacare programme. But, as Larry Brown, NUPGE President points out, it “clearly states the urgent need for national phamacare”. The campaigns of the labour movement and civil society organisations in Canada has thus yielded fruit
A united front of trade unions and civil society organisations in Quebec has demanded the implementation of a national public, universal pharmacare plan. There are lessons to be learnt from the experience of the province since the introduction of an insurance-based drug coverage in 1997. The most important of these, as Fédération Interprofessionnelle de La Santé du Québec has consistently pointed out, is that such public-private systems of insurance do not work and 100% public pharmacare programme is necessary.
Activists across Canada will thus continue to campaign for universal access to prescription drugs as an essential element of the struggle for full realisation of the right to health. This includes urging the advisory council to include a recommendation for national pharmacare to be governed by the principles of the Canada Health Act (CHA) in its final report.