Universal pharmacare is long overdue


Every developed country with a universal health-care system provides universal coverage of prescription drugs except for Canada. Most Canadians do not have access to public drug coverage, and the lack of common purchasing of pharmacare means that we face some of the highest drug prices in the developed world. Canadians pay about 35 per cent more than the median for countries in the Organization for Economic Co-operation and Development (OECD), and Canada has the highest per capita drug expenditure in the OECD after the U.S. It is thus not surprising that public drug spending in Ontario had risen to an estimated 9.6 per cent of the 2018 health budget – up from 1.2 per cent in 1975.

In the absence of a national pharmacare program, many Ontarians rely on a patchwork of existing public drug plans, and the rest have to pay personally or obtain private insurance.

Currently, the Ontario Drug Benefit Program covers seniors, people receiving social assistance, and participants in the Ontario Disability Support Program, while the Trillium Drug Program subsidizes those whose drug costs are high relative to their income. Ontario also offers a number of smaller programs that address specific drug needs. In 2018, an estimated 41.8 per cent of Ontario prescription expenditures were covered by the provincial government, 1.6 per cent by the federal government, and 0.4 per cent by the Workplace Safety and Insurance Board. The other 56.1 per cent was paid by private insurers and out-of-pocket by the public.

The lack of universal pharmacare today forces those who are living with low or modest incomes without access to adequate drug coverage to either go without medication, go into debt or pay out-of-pocket instead of purchasing other life necessities such as food.  The Canadian Medical Association Journal (CMAJ) found that one in 10 Canadians receiving prescriptions reported they did not adhere to them because of the cost. A 2015 Angus Reid survey found that in the past year, 23 per cent of respondents reported they, or another member of their household, did not take drugs as prescribed due to cost. Numerous international studies have also confirmed the health consequences of people not filling prescriptions due to cost.

The inability to pay for medications can cause significant health problems, and in some cases, can be fatal. For example, in Ontario, insufficient drug coverage has been a factor in thousands of avoidable deaths among those with diabetes under the age of 65. We know this because mortality rates drop when people with lower incomes living with diabetes reach 65 because their medication is then covered under the Ontario Drug Benefit program (ODB).

While Universal Pharmacare would benefit all Ontarians, research shows it is particularly important for people with lower incomes, no matter what their health conditions. A 2018 survey of 28,091 Canadians concluded that out-of-pocket charges made drugs unaffordable for 8.2 percent of Canadians who had prescriptions. It also concluded that people facing out-of-pocket expenses were foregoing other necessities, and as a result, were using additional insured health services.

Not only would universal pharma care alleviate stress upon Canada’s already-strained healthcare system from the COVID-19 pandemic, but it would also provide financial benefits to employers and the public.

There are enough studies to show that we can afford universal drug coverage in Canada. They have also called for the elimination of the fragmented pharmaceutical plans in exchange for one drug plan for all Canadians, funded through general tax revenues.

In March, the federal government promised to prioritize implementing a Canada Pharmacare Act by the end of 2023 as part of its supply and confidence agreement with the NDP.

Canadians have been hearing this promise for the past 50 years and so far it remains just a promise.  Not only are they dragging their feet at a time of great stress for a lot of Canadians, but details are scant with respect to the plan to roll out the Canada Pharmacare Act.

Time to get on with it. Canadians should not be forced to choose between their medications and the rest of life’s essentials.