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National pharmacare: A delicate balance

Posted by
Pierre Cyr
Insights

National pharmacare: A delicate balance

Écrit par
Pierre Cyr

One of the most difficult jobs I have ever had to do is attend blood donation drives in honour of toddlers that passed away due to a variety of diseases – some rare, but most, unfortunately not. The look in their parents’ eyes tells it all:  Grief.  Despair.   Bewilderment that they outlived their child. A profound need to honour their legacy.  

Unfortunately, this outcome happens more often than it should. Depending on your postal code, you have varying degrees of access to health services and pharmaceutical drugs.  

Although the Canada Health Act enshrines accessibility as well universality, federal and provincial government officials have for decades sought to constrain its interpretation.  Simply put, we have never lived up to the spirit of the Act.

This is most obvious when approaching the topic of national pharmacare.   Canada is the only country in the world with a universal health care system that does not provide universal coverage for prescription drugs.  Governments question how universality will be costed, and how paying for it will be negotiated by federal, provincial and territorial governments.  While these are valuable and worthwhile debates, they omit the most important lens of all – that of the patient.

We know this issue matters to Canadians: a Mainstreet poll recently indicated that 67.8 per cent of respondents agreed that the federal government should pay for prescription drugs, whether the government can afford it or not. We’ve also been advised that national pharmacare consistently comes up as a top 5 issue in internal party polling being conducted from coast to coast. There is also overwhelming consensus amongst the Liberal grassroots, as well as the Liberal caucus, that something needs to be done on national pharmacare to address serious concerns related to universality and patient access.  

Perhaps surprisingly, almost all of the political parties and parliamentary mechanisms have been moving in lockstep in support of a national pharmacare strategy since the Liberals were elected, with many committee days devoted to the subject by the Standing Committee on Health, culminating in its March 2018 report.

In June, the Advisory Council on the Implementation of National Pharmacare released its final report which costed a national pharmacare strategy at about $25B per year or 10 percent of what was our total health spending in Canada in 2018.   Finance and health officials have been trying to dampen expectations on national pharmacare saying that costing assumptions in the federal government’s advisory council report are too low by half.  The wagons are circling around what they estimate is a $50B per year sticker price, positioning it as unmanageable.

That is why the amendments announced earlier this month to Patented Medicines Regulations were an important next step in signaling the Trudeau Liberals’ ongoing commitment to national pharmacare. The $13.2B over 10 years in potential cost savings for Canadians due to these regulatory changes could be framed as freeing up the resources for the first phase of national pharmacare program.  

While these amendments will likely be well received by Atlantic provinces, as well as British Columbia, the two largest players at the provincial and territorial table – Ontario and Quebec – have the difficult task of opposing these changes – for economic development as well as partisan reasons – even though such “efficiencies” align well with their overall mantra.  Clearly, the significant shift to the right in provincial and territorial governments over the past 18 months, makes anything that encroaches on provincial jurisdiction a more complicated roadmap to navigate.  Most (Conservative) premiers are holding out to negotiate more federal money on the table before they agree to an approach.  At the recent Council of the Federation meeting in Saskatoon, Premiers also requested the ability to opt out of a national strategy. The ongoing negotiations make it so there will be no chance for the Trudeau government to score a win on national pharmacare before October 21.  Come election time, do not be surprised when these same Premiers accuse the Prime Minister of breaking a promise on national pharmacare.  

The Liberals want to make sure that any funding provided to provinces and territories for national pharmacare is earmarked for that purpose.  This is particularly important in Ontario, where the Ford government is poised to make another round of cuts in the Fall Economic Statement.  Premiers will argue that they have no other choice than to use funding as they see fit, given rising costs across the board.  Fueled by decades’ worth of distrust, this standoff won’t be resolved any time soon, especially in such close proximity to the election.

What’s next for a national pharmacare strategy?

The amendments announced in August to Patented Medicines Pricing were much anticipated and likely timed to try and shape a key campaign pillar for the Trudeau Liberals. This was made obvious in Health Canada’s news release with both the headline and Minister Petitpas Taylor’s quote indicating that these “lay the foundation for national pharmacare”. We expect the Trudeau Liberals to provide more details on their strategy to fund drugs for patients with rare diseases, with an initial focus on pediatric drugs. This will respond to recommendations made in the Advisory Council’s report, as well as address concerns raised by provinces and national stakeholder groups like the Canadian Organization for Rare Disorders, about the rising costs of these drugs and the need for a national funding strategy.

In doing so, Prime Minister Trudeau risks being criticized for underdelivering on something that was, if anything, overcommitted to in his first mandate. The good news is that during the hot summer, few were paying attention. Now that Labour Day has passed, the Liberals need to settle on a clear statement that acknowledges the complexity and funding challenges but proposes a phased approach.

This is an important issue for Canadians, and while it is an opportunity for the Trudeau Liberals, it also presents a lot of risk.   Liberals need to strike the right balance of pursuing a framework for national pharmacare without further aggravating provincial and territorial governments during the writ.  Otherwise, they risk painting a bullseye on their backs and making themselves an easy target for a posse of Premiers that are already cocked and loaded.

One thing is clear, the Trudeau Liberals will need a second mandate and a renewed determination in order to make sure they have the political capital necessary to successfully negotiate with provinces and territories. Since timing is everything in politics, it would also be wise for the Liberals to negotiate such a framework leading into the provincial election cycle, so that the tables are turned in terms of who faces Canadians next on this important issue.

Pierre Cyr is Vice-President of Public Affairs at FleishmanHillard Highroad, and previously served as Director of Board and Stakeholder Relations at Canadian Blood Services, as well as Director of Public Appointments and Outreach to an Ontario Minister of Health and Long-Term Care.    Pierre also served in various Chief of Staff and Director roles for two Ontario Premiers, a Federal Leader and eight Ministers.

One of the most difficult jobs I have ever had to do is attend blood donation drives in honour of toddlers that passed away due to a variety of diseases – some rare, but most, unfortunately not. The look in their parents’ eyes tells it all:  Grief.  Despair.   Bewilderment that they outlived their child. A profound need to honour their legacy.  

Unfortunately, this outcome happens more often than it should. Depending on your postal code, you have varying degrees of access to health services and pharmaceutical drugs.  

Although the Canada Health Act enshrines accessibility as well universality, federal and provincial government officials have for decades sought to constrain its interpretation.  Simply put, we have never lived up to the spirit of the Act.

This is most obvious when approaching the topic of national pharmacare.   Canada is the only country in the world with a universal health care system that does not provide universal coverage for prescription drugs.  Governments question how universality will be costed, and how paying for it will be negotiated by federal, provincial and territorial governments.  While these are valuable and worthwhile debates, they omit the most important lens of all – that of the patient.

We know this issue matters to Canadians: a Mainstreet poll recently indicated that 67.8 per cent of respondents agreed that the federal government should pay for prescription drugs, whether the government can afford it or not. We’ve also been advised that national pharmacare consistently comes up as a top 5 issue in internal party polling being conducted from coast to coast. There is also overwhelming consensus amongst the Liberal grassroots, as well as the Liberal caucus, that something needs to be done on national pharmacare to address serious concerns related to universality and patient access.  

Perhaps surprisingly, almost all of the political parties and parliamentary mechanisms have been moving in lockstep in support of a national pharmacare strategy since the Liberals were elected, with many committee days devoted to the subject by the Standing Committee on Health, culminating in its March 2018 report.

In June, the Advisory Council on the Implementation of National Pharmacare released its final report which costed a national pharmacare strategy at about $25B per year or 10 percent of what was our total health spending in Canada in 2018.   Finance and health officials have been trying to dampen expectations on national pharmacare saying that costing assumptions in the federal government’s advisory council report are too low by half.  The wagons are circling around what they estimate is a $50B per year sticker price, positioning it as unmanageable.

That is why the amendments announced earlier this month to Patented Medicines Regulations were an important next step in signaling the Trudeau Liberals’ ongoing commitment to national pharmacare. The $13.2B over 10 years in potential cost savings for Canadians due to these regulatory changes could be framed as freeing up the resources for the first phase of national pharmacare program.  

While these amendments will likely be well received by Atlantic provinces, as well as British Columbia, the two largest players at the provincial and territorial table – Ontario and Quebec – have the difficult task of opposing these changes – for economic development as well as partisan reasons – even though such “efficiencies” align well with their overall mantra.  Clearly, the significant shift to the right in provincial and territorial governments over the past 18 months, makes anything that encroaches on provincial jurisdiction a more complicated roadmap to navigate.  Most (Conservative) premiers are holding out to negotiate more federal money on the table before they agree to an approach.  At the recent Council of the Federation meeting in Saskatoon, Premiers also requested the ability to opt out of a national strategy. The ongoing negotiations make it so there will be no chance for the Trudeau government to score a win on national pharmacare before October 21.  Come election time, do not be surprised when these same Premiers accuse the Prime Minister of breaking a promise on national pharmacare.  

The Liberals want to make sure that any funding provided to provinces and territories for national pharmacare is earmarked for that purpose.  This is particularly important in Ontario, where the Ford government is poised to make another round of cuts in the Fall Economic Statement.  Premiers will argue that they have no other choice than to use funding as they see fit, given rising costs across the board.  Fueled by decades’ worth of distrust, this standoff won’t be resolved any time soon, especially in such close proximity to the election.

What’s next for a national pharmacare strategy?

The amendments announced in August to Patented Medicines Pricing were much anticipated and likely timed to try and shape a key campaign pillar for the Trudeau Liberals. This was made obvious in Health Canada’s news release with both the headline and Minister Petitpas Taylor’s quote indicating that these “lay the foundation for national pharmacare”. We expect the Trudeau Liberals to provide more details on their strategy to fund drugs for patients with rare diseases, with an initial focus on pediatric drugs. This will respond to recommendations made in the Advisory Council’s report, as well as address concerns raised by provinces and national stakeholder groups like the Canadian Organization for Rare Disorders, about the rising costs of these drugs and the need for a national funding strategy.

In doing so, Prime Minister Trudeau risks being criticized for underdelivering on something that was, if anything, overcommitted to in his first mandate. The good news is that during the hot summer, few were paying attention. Now that Labour Day has passed, the Liberals need to settle on a clear statement that acknowledges the complexity and funding challenges but proposes a phased approach.

This is an important issue for Canadians, and while it is an opportunity for the Trudeau Liberals, it also presents a lot of risk.   Liberals need to strike the right balance of pursuing a framework for national pharmacare without further aggravating provincial and territorial governments during the writ.  Otherwise, they risk painting a bullseye on their backs and making themselves an easy target for a posse of Premiers that are already cocked and loaded.

One thing is clear, the Trudeau Liberals will need a second mandate and a renewed determination in order to make sure they have the political capital necessary to successfully negotiate with provinces and territories. Since timing is everything in politics, it would also be wise for the Liberals to negotiate such a framework leading into the provincial election cycle, so that the tables are turned in terms of who faces Canadians next on this important issue.

Pierre Cyr is Vice-President of Public Affairs at FleishmanHillard Highroad, and previously served as Director of Board and Stakeholder Relations at Canadian Blood Services, as well as Director of Public Appointments and Outreach to an Ontario Minister of Health and Long-Term Care.    Pierre also served in various Chief of Staff and Director roles for two Ontario Premiers, a Federal Leader and eight Ministers.

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