National Pharmacare: How close are we?
The idea of National Pharmacare received a lot of media attention in 2019. While there are advantages, disadvantages and political opinions surrounding this potential expansion of the Health Care system, I hope to put these arguments aside and focus on the most significant and realistic problems that would need to be overcome to put any program in place.
1. It’s possibly illegal:
While the federal government is responsible for the delivery of health care services in the territories and in some other limited areas, the majority of health care delivery is managed by the individual provinces. Under the constitution, the federal government sets minimum standards and provides funding while the provinces provide additional funding and delivery.
This means that the federal government cannot simply dictate this type of change but instead must get all provinces on board with the decision. This leads to the next barrier.
2. Quebec:
Anyone involved in the decision-making process for a group benefits plan that operates nationally in Canada knows that when it comes to consistency, Quebec causes issues. For National Pharmacare, there will not be a difference. RAMQ represents the most developed Provincial Pharmacare system but does not deliver on the political promises being made for the National system. This means that instead of following RAMQ’s model, the expectation is that it will change to align with the new system. Given the resurgence of the Bloc Quebecois in the 2019 election, the recent negotiations with the Quebec Pharmacist’s Union and the longstanding and fairly successful and sustainable nature of RAMQ, I feel that it is unlikely that Quebec’s will be quick to embrace this new system
3. Pharma doesn’t want it:
The biggest selling point for a national Pharmacare system is the ability to pool the buying power of all the provinces to negotiate a more favorable pricing with the pharmacare industry. As you can guess, the industry is not exactly thrilled with this prospect and had the deep pockets and political leverage to fight it. The fight has already started. In August, the Canadian arms of Merck & Co, Janssen Inc, Bayer AG, Boehringer Ingelheim and Servier Inc. launched a complaint in Quebec’s Superior Court. They argue that the new Patented Medicine Prices Review Board (PMPRB) which will come into effect July 1, 2020 undermines the provinces ability to negotiate pricing and provide Health Care Services.
The PMPRB is a small step towards a national system, but it is already facing the all three of the major hurdles that a full national system would have to overcome.
While the idea has merits and potential, we are still several years away from implementing a national pharmacare plan. In the meantime, the government will likely continue to take small steps towards a program while facing strong opposition from other political parties, provincial advocates, existing programs and the pharmaceutical industry.