Pharmacare / en 'A tough policy conundrum': U of T expert on the long wait for a national pharmacare strategy /news/tough-policy-conundrum-u-t-expert-long-wait-national-pharmacare-strategy <span class="field field--name-title field--type-string field--label-hidden">'A tough policy conundrum': U of T expert on the long wait for a national pharmacare strategy</span> <div class="field field--name-field-featured-picture field--type-image field--label-hidden field__item"> <img loading="eager" srcset="/sites/default/files/styles/news_banner_370/public/Greg-Marchildon_2.jpg?h=afdc3185&amp;itok=2v_M8jpL 370w, /sites/default/files/styles/news_banner_740/public/Greg-Marchildon_2.jpg?h=afdc3185&amp;itok=TgjFIH1z 740w, /sites/default/files/styles/news_banner_1110/public/Greg-Marchildon_2.jpg?h=afdc3185&amp;itok=41kCgOS9 1110w" sizes="(min-width:1200px) 1110px, (max-width: 1199px) 80vw, (max-width: 767px) 90vw, (max-width: 575px) 95vw" width="740" height="494" src="/sites/default/files/styles/news_banner_370/public/Greg-Marchildon_2.jpg?h=afdc3185&amp;itok=2v_M8jpL" alt="photo of Greg Marchildon"> </div> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span>Christopher.Sorensen</span></span> <span class="field field--name-created field--type-created field--label-hidden"><time datetime="2019-03-29T14:05:01-04:00" title="Friday, March 29, 2019 - 14:05" class="datetime">Fri, 03/29/2019 - 14:05</time> </span> <div class="clearfix text-formatted field field--name-field-cutline-long field--type-text-long field--label-above"> <div class="field__label">Cutline</div> <div class="field__item">Gregory Marchildon, a professor at the şüŔęĘÓƵ's Institute of Health Policy, Management and Evaluation, says Canada is a half-century overdue for a national pharmacare strategy (photo by Alexandru Titeu)</div> </div> <div class="field field--name-field-author-reporters field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/authors-reporters/rebecca-biason" hreflang="en">Rebecca Biason</a></div> </div> <div class="field field--name-field-topic field--type-entity-reference field--label-above"> <div class="field__label">Topic</div> <div class="field__item"><a href="/news/topics/our-community" hreflang="en">Our Community</a></div> </div> <div class="field field--name-field-story-tags field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/tags/institute-health-policy-management-and-evaluation" hreflang="en">Institute of Health Policy Management and Evaluation</a></div> <div class="field__item"><a href="/news/tags/dalla-lana-school-public-health" hreflang="en">Dalla Lana School of Public Health</a></div> <div class="field__item"><a href="/news/tags/pharmacare" hreflang="en">Pharmacare</a></div> </div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The recent federal budget pledged to move forward on a national pharmacare strategy. That potentially includes the creation of the Canadian Drug Agency, a national drug agency that would “take a co-ordinated approach to assessing effectiveness and negotiating prescription drug prices on behalf of Canadians.”</p> <p>But there's a caveat: The budget only committed to giving Health Canada $35 million over four years to further support the development of the idea.</p> <p>The budget also&nbsp;earmarked $1 billion per year over two years, plus $500 million per year ongoing, to help cover the cost of drugs for rare diseases&nbsp;– funding that isn’t slated to begin flowing until 2022-2023.</p> <p>“We are 50 years overdue for a national pharmacare strategy – we have attempted to create one before, have withdrawn it twice, and now the possibility of one looks extremely fragile,” says&nbsp;<strong>Gregory Marchildon</strong>, a professor at the şüŔęĘÓƵ's&nbsp;Institute of Health Policy, Management and Evaluation and an expert on pharmacare.</p> <p>Marchildon, who is also the director of the North American Observatory on Health Systems and Policies, believes the government could choose from a few options if it is willing to endure some short-term financial pain in order to reap long-term cost benefits.&nbsp;</p> <p>“We could have a single-payer, universal and national plan, where no matter what province or territory you lived in, moved to, or travelled in, your drug coverage would be the same,” says Marchildon.</p> <p>“This pan-Canadian option, governed by strict federal standards, would have very few barriers to access – or none.”</p> <p>A second option, according to Marchildon, could involve a “multi-payer system in which employment-based insurance plans are subsidized by the government.”</p> <div> <p>Marchildon spoke with writer <strong>Rebecca Biason </strong>about the current patchwork system in place and why, from a public policy perspective, developing a national&nbsp;pharmacare plan remains so elusive.</p> <hr> <p><strong>What is our pharmacare system like right now?</strong></p> </div> <p>It is an uneven plan, governed separately by each province and territory with a lot of variation in terms of which drugs are covered and added to the Canadian Drug Association (CDA) formulary, as well as the cost of co-payments. In many provinces, it is only once individuals retire that they really see how minimal their coverage is. Unsurprisingly, the richer the province and the larger the population, the more comprehensive the drug plan and the less co-payments are required. The difference between coverage in Ontario and the Atlantic Provinces, for example, would be quite glaring.</p> <p><strong>How would better and universal coverage be beneficial?</strong></p> <p>Currently, 20 per cent of Canadians are going without medications because of the lack of coverage and the high cost of drugs. With a truly universal single-tier system, comprehensive coverage of an essential list of medications would be available for everyone regardless of income or place of residence across the country. There would need to be strict evaluations of which drugs could be included in the CDA formulary with drugs being tested for both their performance effectiveness and cost effectiveness.</p> <p>Additionally, provincial and territorial governments, through the CDA, would have the ability to negotiate harder and more effectively with pharmaceutical companies to reduce drug prices.</p> <p>For example, if the CDA sought to purchase a drug, say, for an inoculation against a disease like the flu, where it would be distributed directly to the public, bulk purchasing could be done in the public interest and at a low cost.</p> <p><strong>What does the future of pharmacare look like for Canadians?</strong></p> <p>The recent federal budget announcement shows that the government has spread money across lots of different places but there has been no focus on any big initiatives. You need to have a focused budget to successfully bring about a pharmacare program. There has been little strategic discussion on how a program would be implemented but the federal committee on pharmacare is emphasizing collaboration with provinces, leading us to believe that the federal government does not want a pharmacare initiative to fall on their shoulders alone.</p> <p>Pharmacare has always been a tough policy conundrum. It is hard to fix a system that seems to be working for folks in the middle class, even at a high cost. Some people may not recognize the stress and strain of those who do not have private plans. Those individuals who are low income – and often marginalized with no access to private insurance plans – do not have a voice and are not given the opportunity to express how difficult it is for them to purchase essential medications.</p> <p>It would be ideal for political parties in this election year to deliver a blueprint plan that shows an active discussion about the appropriate design of pharmacare and what we might achieve with a single-payer system. The public could then make a true choice and it would help to alleviate confusion around this debate.</p> <p>We have a faint hope through both the upcoming June report from the federal committee on pharmacare and the budget, but what the reality will be for the future of Canadian phamacare seems both vague and very distant.</p> </div> <div class="field field--name-field-news-home-page-banner field--type-boolean field--label-above"> <div class="field__label">News home page banner</div> <div class="field__item">Off</div> </div> Fri, 29 Mar 2019 18:05:01 +0000 Christopher.Sorensen 155924 at NAFTA negotiations may threaten pharmacare: U of T expert /news/nafta-negotiations-may-threaten-pharmacare-u-t-expert <span class="field field--name-title field--type-string field--label-hidden">NAFTA negotiations may threaten pharmacare: U of T expert</span> <div class="field field--name-field-featured-picture field--type-image field--label-hidden field__item"> <img loading="eager" srcset="/sites/default/files/styles/news_banner_370/public/2018-09-10-pharmacare-resized.jpg?h=58088d8b&amp;itok=d9jP0wiA 370w, /sites/default/files/styles/news_banner_740/public/2018-09-10-pharmacare-resized.jpg?h=58088d8b&amp;itok=81B3GTaS 740w, /sites/default/files/styles/news_banner_1110/public/2018-09-10-pharmacare-resized.jpg?h=58088d8b&amp;itok=X6w8aFIw 1110w" sizes="(min-width:1200px) 1110px, (max-width: 1199px) 80vw, (max-width: 767px) 90vw, (max-width: 575px) 95vw" width="740" height="494" src="/sites/default/files/styles/news_banner_370/public/2018-09-10-pharmacare-resized.jpg?h=58088d8b&amp;itok=d9jP0wiA" alt="Photo of man holding drugs"> </div> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span>noreen.rasbach</span></span> <span class="field field--name-created field--type-created field--label-hidden"><time datetime="2018-09-10T14:26:32-04:00" title="Monday, September 10, 2018 - 14:26" class="datetime">Mon, 09/10/2018 - 14:26</time> </span> <div class="clearfix text-formatted field field--name-field-cutline-long field--type-text-long field--label-above"> <div class="field__label">Cutline</div> <div class="field__item"> The ongoing NAFTA renegotiations could put a Canadian national pharmacare program in jeopardy, and could have a particular impact on Canadians who need expensive arthritis drugs, says U of T's Joel Lexchin (photo by Shutterstock)</div> </div> <div class="field field--name-field-author-reporters field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/authors-reporters/joel-lexchin" hreflang="en">Joel Lexchin</a></div> </div> <div class="field field--name-field-topic field--type-entity-reference field--label-above"> <div class="field__label">Topic</div> <div class="field__item"><a href="/news/topics/city-culture" hreflang="en">City &amp; Culture</a></div> </div> <div class="field field--name-field-story-tags field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/tags/free-trade" hreflang="en">Free Trade</a></div> <div class="field__item"><a href="/news/tags/pharmacare" hreflang="en">Pharmacare</a></div> <div class="field__item"><a href="/news/tags/conversation" hreflang="en">The Conversation</a></div> </div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h1><span></span></h1> <p>Around <a href="http://angusreid.org/prescription-drugs-canada/">91 per cent of Canadians want a national pharmacare plan</a>, according to a recent national poll, so they don’t have to choose between buying groceries or paying for drugs to keep them healthy.</p> <p>The same public opinion survey has also found that prescription drug access and affordability are issues for almost 25 per cent of Canadian households.</p> <p>But depending on what happens with the ongoing North American Free Trade Agreement (NAFTA) renegotiations, the cost of such a pharmacare plan could go up, possibly dramatically.</p> <p>This has to do with something called intellectual property rights (IPRs). Usually when talk turns to IPRs people think about patents. But there’s also something called data protection.</p> <p>The data that’s being protected is information about the effectiveness and safety of drugs that comes out of the clinical trials that brand name drug companies do when they want approval to market a new drug.</p> <h3>Generic drugs essential to pharmacare</h3> <p>The data is the private property of the brand name companies and can’t be used by anyone else, including generic companies, for a period of time.</p> <p>It would be very costly for generic companies to do the original testing all over again, and it would also be unethical because the results of the trials are already known. So generic companies use the data once it’s no longer protected.</p> <p>Data protection is not a sexy topic, but it’s important in determining how quickly some low-cost generics can reach the market. The presence of generics keeps public drug plans affordable and will be essential for any pharmacare plan.</p> <p>Right now, <a href="http://canadiangenerics.ca/get-the-facts/canadian-market-facts/">seven out of every 10 prescriptions</a> are filled with generic drugs, but paying for generics only uses up 21 cents out of every dollar that is spent on prescription drugs in Canada. A generic prescription is about one-third the price of a brand name one.</p> <p>Patents already mean that brand name drugs are on the Canadian market <a href="https://www.sciencedirect.com/science/article/pii/S1098301517302504">for more than 12 years without any competition</a>. When patents run out, generic drugs can be sold, but sometimes patents expire before the data protection period is up. Until the data protection period ends, there can’t be any generics. What’s more, unlike patents, data protection can’t be challenged in the courts.</p> <h3>Ten years of data exclusivity</h3> <p>Canada used to offer five years of data protection but both the <a href="https://anzhealthpolicy.biomedcentral.com/articles/10.1186/1743-8462-4-8">lobby group for Big Pharma here</a> and <a href="http://www.cptech.org/ip/health/phrma/301-00/canada.html">in the United States</a> found that time period unacceptable.</p> <p>In the end, as a result of the lobbying efforts by the pharmaceutical industry, <a href="http://www.wipo.int/edocs/lexdocs/laws/en/ca/ca053en.pdf">Canada amended its regulations</a> on data protection to allow for eight years of data exclusivity. An extra six months is possible if the company marketing the drug is able to determine that children need the drug.</p> <p>Now comes word that in the bilateral United States-Mexico NAFTA talks, there was an agreement that <a href="https://www.statnews.com/pharmalot/2018/08/29/mexico-trade-rep-data-protection/">biologics will have 10 years of data exclusivity</a>.</p> <p>Biologics are injectable drugs that are used to treat various forms of arthritis, Crohn’s disease and ulcerative colitis (inflammatory bowel conditions), multiple sclerosis and a variety of other diseases.</p> <p>Biologics can be very effective but they come with a high cost.</p> <h3>Big money spent on biologics</h3> <p>According to the latest report from the Patented Medicine Prices Review Board, a federal agency that sets a maximum introductory price for new patented medicines, <a href="http://www.pmprb-cepmb.gc.ca/CMFiles/Publications/Annual%20Reports/2018/2017_Annual_Report_Final_EN.pdf">biologics accounted for seven of the top 10 patented drugs in Canada</a> based on the amount spent in 2017.</p> <p>No. 1 on the list is infliximab (Remicade), used in the treatment of rheumatoid arthritis and ulcerative colitis, among other illnesses. The average annual cost for a course of treatment with Remicade is close to $29,000 and, in total, just shy of $1 billion was spent on this one medicine alone in 2017 by patients, provincial drug plans and private insurers.</p> <p>No. 6 on the list is etanercept (Enbrel) also used for various forms of arthritis. The average annual cost for Enbrel is $13,600.</p> <p>But for some of these biologics, there is the rough equivalent of a generic, known as a “subsequent entry biologic (SEB).” Whereas a <a href="https://www.formulary.health.gov.on.ca/formulary/">single dose of Enbrel costs $406, a single dose of its SEB is only $255</a> – more than a third less expensive.</p> <p>If the U.S. pushes Canada to accept the same data protection period that Mexico did, then data protection here goes up by another 1.5 to two years. Then we might very well be spending a lot more on some biologics, because the SEBs will be delayed.</p> <p>If we want a national pharmacare system, then we need to make sure that our negotiators don’t give in to any American demands about medical data protection.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img alt="The Conversation" height="1" src="https://counter.theconversation.com/content/102851/count.gif?distributor=republish-lightbox-basic" style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important" width="1" loading="lazy"><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: http://theconversation.com/republishing-guidelines --></p> <p><em>Joel Lexchin&nbsp;is an associate professor of&nbsp;family and community medicine at the&nbsp;şüŔęĘÓƵ, professor emeritus of health policy and management at York University, and an emergency physician at the University Health Network.&nbsp;</em></p> <p><em>This article was originally published on&nbsp;The Conversation. Read the&nbsp;<a href="https://theconversation.com/nafta-negotiations-may-threaten-pharmacare-102851">original article</a>, including his disclosure statement.</em></p> <p>&nbsp;</p> </div> <div class="field field--name-field-news-home-page-banner field--type-boolean field--label-above"> <div class="field__label">News home page banner</div> <div class="field__item">Off</div> </div> Mon, 10 Sep 2018 18:26:32 +0000 noreen.rasbach 142604 at U of T expert on pharmacare and the 'chaotic world' of Canadian drug prices /news/u-t-expert-pharmacare-and-chaotic-world-canadian-drug-prices <span class="field field--name-title field--type-string field--label-hidden">U of T expert on pharmacare and the 'chaotic world' of Canadian drug prices </span> <div class="field field--name-field-featured-picture field--type-image field--label-hidden field__item"> <img loading="eager" srcset="/sites/default/files/styles/news_banner_370/public/2018-03-19-hoskins-resized.jpg?h=afdc3185&amp;itok=jeNOqYy1 370w, /sites/default/files/styles/news_banner_740/public/2018-03-19-hoskins-resized.jpg?h=afdc3185&amp;itok=qys1bnKH 740w, /sites/default/files/styles/news_banner_1110/public/2018-03-19-hoskins-resized.jpg?h=afdc3185&amp;itok=IZipi1ec 1110w" sizes="(min-width:1200px) 1110px, (max-width: 1199px) 80vw, (max-width: 767px) 90vw, (max-width: 575px) 95vw" width="740" height="494" src="/sites/default/files/styles/news_banner_370/public/2018-03-19-hoskins-resized.jpg?h=afdc3185&amp;itok=jeNOqYy1" alt="Photo of Eric Hoskins"> </div> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span>noreen.rasbach</span></span> <span class="field field--name-created field--type-created field--label-hidden"><time datetime="2018-03-19T16:30:27-04:00" title="Monday, March 19, 2018 - 16:30" class="datetime">Mon, 03/19/2018 - 16:30</time> </span> <div class="clearfix text-formatted field field--name-field-cutline-long field--type-text-long field--label-above"> <div class="field__label">Cutline</div> <div class="field__item">Could universal pharmacare reduce excessive drug price hikes in Canada? Eric Hoskins, former Ontario minister of health, will chair a federal advisory council to implement a national pharmacare plan (photo by Andrew Francis Wallace/Toronto Star)</div> </div> <div class="field field--name-field-author-reporters field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/authors-reporters/joel-lexchin" hreflang="en">Joel Lexchin</a></div> </div> <div class="field field--name-field-topic field--type-entity-reference field--label-above"> <div class="field__label">Topic</div> <div class="field__item"><a href="/news/topics/our-community" hreflang="en">Our Community</a></div> </div> <div class="field field--name-field-story-tags field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/tags/faculty-medicine" hreflang="en">Faculty of Medicine</a></div> <div class="field__item"><a href="/news/tags/global" hreflang="en">Global</a></div> <div class="field__item"><a href="/news/tags/pharmacare" hreflang="en">Pharmacare</a></div> <div class="field__item"><a href="/news/tags/conversation" hreflang="en">The Conversation</a></div> </div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h1><span></span></h1> <p>The cost of a life-saving drug to treat cystinosis – a rare disease affecting probably 100 people across Canada – is soon to rise from <a href="http://www.cbc.ca/news/health/second-opinion-procysbi-cystagon-march10-1.4570152">$10,000 per year to more than $300,000 annually</a>.</p> <p>The new form of the drug, Procysbi, contains the same active ingredient as the old form of the drug, Cystagon. It differs only in that it contains a new coating, enabling a slower release of chemicals into the body.</p> <p><a href="http://www.gazette.gc.ca/rp-pr/p1/2017/2017-12-02/html/reg2-eng.html">Reforms to the Patented Medicine Prices Review Board (PMPRB)</a>, a federal agency that sets a maximum introductory price for new patented drugs, could help rein in this type of increase.</p> <p>But a coalition of patient groups, some partially funded by drug companies, want Canada’s health minister and Health Canada to <a href="https://www.newswire.ca/news-releases/canadian-patient-groups-call-on-federal-health-minister-to-halt-the-process-examining-proposed-amendments-to-the-patented-medicine-regulations-pending-constructive-consultations-674144623.html">stop this reform process</a>. They argue that lowering drug prices in the manner proposed could limit access to new drugs.</p> <p>The drug companies are backing them up.</p> <h3>Canadians pay the price</h3> <p><a href="http://healthydebate.ca/2018/03/topic/canada-drug-prices">According to Pamela Fralick</a>, the CEO of Innovative Medicines Canada (IMC), the lobby group representing the multinational drug company subsidiaries operating in Canada: “The proposed changes would negatively affect patients by slowing and limiting access to new, life-saving medicines and vaccines, and will have consequences for investment and employment in Canada’s life science sector.”</p> <p>IMC and its predecessors have been making the same type of veiled threat since the early 1970s, when Manitoba introduced its public drug formulary, a list of drugs the province would cover.</p> <figure class="align-center "><img alt src="https://images.theconversation.com/files/210172/original/file-20180313-30958-lqf885.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip"> <figcaption><em><span class="caption">With a national pharmacare plan, all Canadians would benefit from lower drug prices&nbsp;</span><span class="attribution"><span class="source">(photo by Shutterstock)</span></span></em></figcaption> </figure> <p>While there are drugs that are not sold in Canada, the reason is the relatively small Canadian market, not the price.</p> <p>In fact, when it comes to paying for prescription drugs, <a href="http://dx.doi.org/10.1787/health_glance-2017-en">only the United States and Switzerland outspend Canada</a> on a per capita basis out of 31 industrialized countries in the Organization for Economic Co-operation and Development.</p> <p>There are now <a href="http://www.pmprb-cepmb.gc.ca/view.asp?ccid=1334">19 drugs on the Canadian market that cost $50,000 or more per year</a>, compared to just six a decade ago.</p> <p>And, contrary to what IMC claims and what the patient groups seem to believe, <a href="http://www.pmprb-cepmb.gc.ca/view.asp?ccid=1334">only one in 10 new drugs are actually major therapeutic improvements</a>.</p> <h3>Increase of 3,000 per cent</h3> <p>The dramatic rise in the cost of treating cystinosis – a genetic disease that causes kidney damage – reflects the dysfunctional nature of the way Canada controls drug prices.</p> <p>Up until now, the treatment has been a product called Cystagon that must be vetted by Health Canada on a patient-by-patient basis since it’s not approved for sale in Canada. Now the newer version of the drug, Procysbi, made by Horizon Pharma – and taken twice instead of four times daily – is being marketed in Canada.</p> <p>With the advent of Procysbi, the cheaper Cystagon will no longer be available to Canadian patients. Under the current rules enforced by the PMPRB, Procysbi is treated as a “breakthrough drug,” which is why the 3,000-per-cent price increase was permitted.</p> <p>Again,&nbsp;the only difference between Cystagon and Procysbi is the latter has a special coating enabling its release into the body more slowly.</p> <p>All of the basic research and development of Procysbi was <a href="http://www.cbc.ca/news/health/second-opinion-procysbi-cystagon-march10-1.4570152">financed by patient groups, not drug companies</a>. Horizon Pharma has not publicly offered any reason for the price it plans to charge. The company is going to offer the drug for free for a limited time, but what happens when that option ends?</p> <p>This isn’t the first time there’s been sticker shock about drug prices in Canada. In September 2017, the PMPRB ordered <a href="http://www.cbc.ca/news/health/solaris-pmprb-1.4310249">Alexion Pharmaceuticals to lower the $700,000 annual cost of Soliris</a>, used in the treatment of rare blood disorders.</p> <p>The pan-Canadian Pharmaceutical Alliance, a coalition of provincial and federal drug plans, bargains with companies for lower prices and is in negotiations with Horizon Pharma. But even if it can secure a discount, that will only apply to what provincial drug plans pay.</p> <p>Private drug plans and people paying out of pocket, assuming anyone could actually afford Procysbi, will not get the discount.</p> <h3>National pharmacare a solution</h3> <p>A <a href="https://theconversation.com/canadian-pharmacare-is-closer-to-becoming-a-reality-92646">national pharmacare plan</a> could help to bring some order to the chaotic world of Canadian drug prices. Everyone in the country would be covered under a public plan and benefit from the lower drug prices that would be achieved.</p> <p>Pharmacare doesn’t necessarily mean that drugs will sell for pennies. But based on the experience in other countries, we will be much better off.</p> <p>If companies don’t like the price being offered, then they could still try to sell their drugs to those who could afford them, but the market would typically be very small, encouraging the companies to lower prices.</p> <p>However, Finance Minister Bill Morneau doesn’t seem interested in a universal pharmacare plan, <a href="http://www.richmond-news.com/cmlink/gmg-glacier-media-group/2.2062/critics-call-for-morneau-s-ouster-from-pharmacare-file-over-remarks-about-study-1.23189183">preferring to try to fill gaps and add to the patchwork</a> in the existing system, although now he seems to be backing off from his initial comments.</p> <p>Perhaps people with cystinosis should ask Morneau to cover their costs.</p> <p><span><em>Joel Lexchin&nbsp;is a board member of Canadian Doctors for Medicare, professor emeritus of health policy and management at York University, and associate professor of family and community medicine at the şüŔęĘÓƵ.</em></span></p> <p><em>This article was originally published on <a href="http://theconversation.com">The Conversation</a>. Read the <a href="https://theconversation.com/pharmacare-and-the-chaotic-world-of-canadian-drug-prices-93343">original article</a>.</em></p> <p><img alt="The Conversation" height="1" src="https://counter.theconversation.com/content/93343/count.gif?distributor=republish-lightbox-basic" width="1" loading="lazy"></p> </div> <div class="field field--name-field-news-home-page-banner field--type-boolean field--label-above"> <div class="field__label">News home page banner</div> <div class="field__item">Off</div> </div> Mon, 19 Mar 2018 20:30:27 +0000 noreen.rasbach 131704 at National pharmacare plan a step in right direction for Canadians: U of T expert /news/national-pharmacare-plan-step-right-direction-canadians-u-t-expert <span class="field field--name-title field--type-string field--label-hidden">National pharmacare plan a step in right direction for Canadians: U of T expert</span> <div class="field field--name-field-featured-picture field--type-image field--label-hidden field__item"> <img loading="eager" srcset="/sites/default/files/styles/news_banner_370/public/2018-03-06-drugs-resized.jpg?h=afdc3185&amp;itok=fGnpVeB0 370w, /sites/default/files/styles/news_banner_740/public/2018-03-06-drugs-resized.jpg?h=afdc3185&amp;itok=JwYI-zAl 740w, /sites/default/files/styles/news_banner_1110/public/2018-03-06-drugs-resized.jpg?h=afdc3185&amp;itok=j19k1wtu 1110w" sizes="(min-width:1200px) 1110px, (max-width: 1199px) 80vw, (max-width: 767px) 90vw, (max-width: 575px) 95vw" width="740" height="494" src="/sites/default/files/styles/news_banner_370/public/2018-03-06-drugs-resized.jpg?h=afdc3185&amp;itok=fGnpVeB0" alt="Photo of prescription drugs"> </div> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span>noreen.rasbach</span></span> <span class="field field--name-created field--type-created field--label-hidden"><time datetime="2018-03-06T00:00:00-05:00" title="Tuesday, March 6, 2018 - 00:00" class="datetime">Tue, 03/06/2018 - 00:00</time> </span> <div class="field field--name-field-author-reporters field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/authors-reporters/rebecca-biason" hreflang="en">Rebecca Biason</a></div> </div> <div class="field field--name-field-topic field--type-entity-reference field--label-above"> <div class="field__label">Topic</div> <div class="field__item"><a href="/news/topics/city-culture" hreflang="en">City &amp; Culture</a></div> </div> <div class="field field--name-field-story-tags field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/tags/dalla-lana-school-public-health" hreflang="en">Dalla Lana School of Public Health</a></div> <div class="field__item"><a href="/news/tags/health" hreflang="en">Health</a></div> <div class="field__item"><a href="/news/tags/pharmacare" hreflang="en">Pharmacare</a></div> </div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The federal government has set in motion a possible national pharmacare plan by creating&nbsp;an&nbsp;advisory council as part of last week's budget.</p> <p>Although Ottawa has yet to attribute funding to the program, setting up a national advisory council, chaired by Eric Hoskins, Ontario's former minister of health and long-term care, is a serious step in the right direction, said health policy expert <strong>Gregory Marchildon,&nbsp;</strong>a professor at the Institute of Health Policy, Management and Evaluation (IHPME).</p> <p><img alt class="media-image attr__typeof__foaf:Image img__fid__7745 img__view_mode__media_large attr__format__media_large" src="/sites/default/files/2018-03-06-marchildon-350.jpg" style="width: 400px; height: 256px; margin: 10px; float: left;" typeof="foaf:Image">“National pharmacare addresses the unfinished business of Medicare, including not only improved access to medications for the working poor and part-time workers, but also lowered drug costs, and increased mobility for workers looking for jobs in other provinces. These individuals would no longer be limited in terms of career movement by their drug coverage in a particular region or employment benefit plan,” said Marchildon, who is also director of the <a href="http://ihpme.utoronto.ca/research/research-centres-initiatives/nao/">North American Observatory on Health Systems and Policies</a>.</p> <p>According to Marchildon, a national coverage plan could fit one of two models: a single-payer plan implemented by the provinces and territories under a set of federal standards similar to our current Medicare coverage, or a federal program that is regulated, financed, and administered by the federal government, and provided to Canadians directly.</p> <p>“Now is the time to develop a comprehensive structure, as the differences in federal, provincial and territorial coverage plans grow, and as the breadth and depth of coverage in private, employment-based drug plans continues to decline,” he said.</p> <p><strong>Rebecca Biason </strong>of IHPME in the Dalla Lana School of Public Health&nbsp;spoke with Marchildon about the next stages in the process of a national pharmacare plan.</p> <hr> <p><strong>What does the advisory council need to focus on to move forward?</strong></p> <p>The Parliamentary Committee on Health is about to release its report on a national pharmacare program. Assuming the all-party committee recommends in favour, there may still be a need for a follow-up study on how a national plan might work so that we can construct the best administrative machine and determine what national pharmacare would look like in terms of the breadth and depth of coverage.</p> <h3><a href="https://toronto.ctvnews.ca/video?clipId=1336078&amp;playlistId=1.3820368&amp;binId=1.3378530&amp;playlistPageNum=1">Watch Gregory&nbsp;Marchildon on&nbsp;<em>CTV National</em>’s federal budget coverage</a></h3> <p>The breadth of coverage would likely have to be broad as we take into consideration the variety of current plans available throughout the country. Any proposed pharmacare plan would have to meet the expectations of those living with fairly good private or public coverage.Hopefully the recommendation would be to provide better coverage than that which the majority of Canadians have at present.</p> <p><strong>What about co-payments or deductibles?</strong></p> <p>This is probably the most difficult decision when it comes to building a national plan, and falls under the depth of coverage. The council would need to decide whether certain medications are free at the point of access, or whether they will require co-payments or deductibles. A tiered system might even be discussed, with classes of drugs, some free, some needing a minimal payment, and others a more substantial co-payment.</p> <p><strong>How does Canada compare with other countries?</strong></p> <p>Countries like Australia and New Zealand already have national drug coverage plans, but they are managed in different ways, such as by agencies or Crown corporations while many European countries already have drug coverage worked into their universal health plans. The council will need to assess the way these countries have structured their plans and determine what will be most suitable for Canadians.</p> <p><strong>What are some of the barriers ahead in creating a comprehensive plan?</strong></p> <p>Pharmaceutical companies are going to be affected, as drug prices fall and cost controls come into effect under either coverage model. These companies can choose to work with the new plan, and maximize their benefits including providing drugs at lower prices but gaining the benefits of a larger market as more people have access to the medications they need. Or, they can choose to fight national pharmacare from the beginning.</p> <p>They are more than capable of sowing the seeds of doubt about the development of the plan and its impact on job losses, particularly in Ontario and Quebec, where most Canadian pharmaceuticals are manufactured. They can also lobby or otherwise influence politicians, ministers, provincial governments or other groups who might oppose such a plan.</p> <p>There will likely be a very long road ahead leading into the 2019 election and the establishment of national pharmacare.</p> <p>&nbsp;</p> </div> <div class="field field--name-field-news-home-page-banner field--type-boolean field--label-above"> <div class="field__label">News home page banner</div> <div class="field__item">Off</div> </div> Tue, 06 Mar 2018 05:00:00 +0000 noreen.rasbach 130765 at Health minister says drug costs are “way out of control” but change is on the way /news/health-minister-says-drug-costs-are-way-out-control-change-way <span class="field field--name-title field--type-string field--label-hidden">Health minister says drug costs are “way out of control” but change is on the way</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span>sgupta</span></span> <span class="field field--name-created field--type-created field--label-hidden"><time datetime="2016-01-18T01:15:10-05:00" title="Monday, January 18, 2016 - 01:15" class="datetime">Mon, 01/18/2016 - 01:15</time> </span> <div class="clearfix text-formatted field field--name-field-cutline-long field--type-text-long field--label-above"> <div class="field__label">Cutline</div> <div class="field__item"> Alan Dean Photography)</div> </div> <div class="field field--name-field-author-reporters field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/authors-reporters/alan-christie" hreflang="en">Alan Christie</a></div> </div> <div class="field field--name-field-author-legacy field--type-string field--label-above"> <div class="field__label">Author legacy</div> <div class="field__item">Alan Christie</div> </div> <div class="field field--name-field-topic field--type-entity-reference field--label-above"> <div class="field__label">Topic</div> <div class="field__item"><a href="/news/topics/global-lens" hreflang="en">Global Lens</a></div> </div> <div class="field field--name-field-story-tags field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/tags/features" hreflang="en">Features</a></div> <div class="field__item"><a href="/news/tags/pharmacare" hreflang="en">Pharmacare</a></div> <div class="field__item"><a href="/news/tags/medicine" hreflang="en">Medicine</a></div> <div class="field__item"><a href="/news/tags/international" hreflang="en">International</a></div> <div class="field__item"><a href="/news/tags/health" hreflang="en">Health</a></div> <div class="field__item"><a href="/news/tags/alumni" hreflang="en">Alumni</a></div> <div class="field__item"><a href="/news/tags/global" hreflang="en">Global</a></div> </div> <div class="field field--name-field-subheadline field--type-string-long field--label-above"> <div class="field__label">Subheadline</div> <div class="field__item">Dr. Jane Philpott brings years of U of T experience to a crucial cabinet position</div> </div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Dr. <strong>Jane Philpott</strong> would love to be in Addis Ababa in a few weeks to see the first students graduate from a family medicine program she was instrumental in establishing while at the şüŔęĘÓƵ.</p> <p>Unfortunately, she will have to miss the graduation. She is too busy running Canada’s health-care system.</p> <p>In November, Prime Minister Justin Trudeau named Philpott minister of health. It is perhaps the most important portfolio in government, after the prime minister and finance minister and an&nbsp;extraordinary achievement for a neophyte MP elected&nbsp;to the riding of Markham-Stouffville.</p> <p>It&nbsp;was&nbsp;a remarkable&nbsp;posting in another way: she is the first medical doctor to become federal minister of health.&nbsp;</p> <p>Philpott’s connection to U of T goes back to the 1980s when she spent a year doing a fellowship with Dr. <strong>Jay Keystone</strong> on tropical medicine after completing her family medicine residency at the University of Ottawa.&nbsp;</p> <p>In 2012 she completed her master’s degree in public health at U of T and holds&nbsp;a clinical, part-time appointment with the department of family and community medicine at U of T at the rank of associate professor.&nbsp;</p> <p>“I had an absolutely fabulous experience studying as a mature student at U of T,” Philpott told <em>U of T News</em>. “It was very helpful at that stage of my career.</p> <p>“I can’t say enough about the Faculty of Medicine. I worked with a lot of outstanding colleagues over the years. And as a graduate student, the amount of courses available was absolutely stunning.</p> <p>“My experience really deepened my understanding of the health-care system and health policy. It was tremendously enriching for me both personally and professionally.”</p> <p>Another enriching experience was her leadership role in the Faculty of Medicine’s Toronto Addis Ababa Academic Collaboration.</p> <h2><a href="http://news.utoronto.ca/tags/taaac">Read more about TAAAC</a></h2> <p>“It is a really wonderful collaboration that is helping the University of Addis Ababa with their clinical training at the post-graduate level,” she said.</p> <p>The first nine students are set to graduate in the next few weeks. The program began in 2013. “I wish I could be over there in Ethiopia but I have to miss it because of my parliamentary obligations.”</p> <p>Those obligations are immense. They start with her first formal meeting with &nbsp;provincial and territorial health ministers in Vancouver on Jan. 20 and&nbsp;21.</p> <p>The Liberals promised during the federal election campaign to negotiate a new health accord with the provinces, with long-term funding commitments. Philpott has talked already to most of the health ministers over the phone. “I am optimistic that over the months we can come up with a shared health agenda,” she said.</p> <p>While provincial governments are responsible for health-care spending, Philpott said the federal government can take a leadership role in setting policy on such crucial issues as access to home care and mental health care, lowering prices of pharmaceutical drugs and expanding innovation across the health care system.</p> <p>During the election campaign, several U of T experts, including Dr. <strong>Samir Sinha</strong> and Dr. <strong>Danielle Martin</strong>, pushed strongly for a national pharmacare program.&nbsp;</p> <h2><a href="http://news.utoronto.ca/election-2015-national-plan-needed-canadas-aging-population">Read more about pharmacare</a></h2> <p>“All those experts making smart recommendations will be very pleased to see the kind of work we will be doing as a federal government,” Philpott said.</p> <p>“I absolutely hope we will be able to work towards a national pharmacare plan at some point, but the very first step to be taken is addressing the cost of prescription drugs.” Drug costs, she said, “have gotten way out of control” in Canada, which has the second highest per-capita drug costs in the world, after the United States.</p> <p>“There are a number of mechanisms the federal government has to bring down those drug costs and we will be working quite ambitiously to do that,” Philpott said.</p> <p>One method is bulk buying. &nbsp;Some provinces are part of the Canadian Pharmaceutical Alliance, which buys in bulk, and are asking the federal government to join it. Ottawa is directly responsible for drug costs for some groups, including First Nations people.</p> <p>After Philpott was elected last October, the <em>Globe and Mail</em> reported that she quoted a German doctor-turned-politician, Rudolf Virchow, to the effect that “politics is nothing but medicine writ large.”</p> <p>“It is something that I still very much believe,” she told <em>U of T News</em>. “Politics and medicine are very closely linked.&nbsp;They are both about improving the lives of people. The things that drove me to become a physician are the things that drove me to become a politician.<span style="font-size: 12px; line-height: 18px;">”</span></p> <p>She believes “one of the advantages I will have as federal health minister is that I spent so many years of my life working on the front lines of health care as a family doctor.</p> <p>“I have had conversations and interactions with thousands and thousands &nbsp;of people and seen them at some of the best times of their lives and also seen them during the most difficult times of their lives. Those peoples’ stories are etched in my mind and will certainly shape me in the kinds of decisions that I make at the policy level.</p> <p>“Government policies have a real impact on real people, and I have worked with those real people and will certainly be pressed to make sure decisions made under my watch will be ones that will help improve peoples’ lives.” &nbsp;</p> </div> <div class="field field--name-field-news-home-page-banner field--type-boolean field--label-above"> <div class="field__label">News home page banner</div> <div class="field__item">Off</div> </div> <div class="field field--name-field-picpath field--type-string field--label-above"> <div class="field__label">picpath</div> <div class="field__item">sites/default/files/2016-01-18-Jane_Philpott.jpg</div> </div> Mon, 18 Jan 2016 06:15:10 +0000 sgupta 7587 at Election 2015: National plan needed for Canada's aging population /news/election-2015-national-plan-needed-canadas-aging-population <span class="field field--name-title field--type-string field--label-hidden">Election 2015: National plan needed for Canada's aging population</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span>sgupta</span></span> <span class="field field--name-created field--type-created field--label-hidden"><time datetime="2015-09-21T12:49:15-04:00" title="Monday, September 21, 2015 - 12:49" class="datetime">Mon, 09/21/2015 - 12:49</time> </span> <div class="clearfix text-formatted field field--name-field-cutline-long field--type-text-long field--label-above"> <div class="field__label">Cutline</div> <div class="field__item">(photo by Benny Lin via Flickr)</div> </div> <div class="field field--name-field-author-reporters field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/authors-reporters/alan-christie" hreflang="en">Alan Christie</a></div> </div> <div class="field field--name-field-author-legacy field--type-string field--label-above"> <div class="field__label">Author legacy</div> <div class="field__item">Alan Christie</div> </div> <div class="field field--name-field-story-tags field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/tags/more-news" hreflang="en">More News</a></div> <div class="field__item"><a href="/news/tags/pharmacare" hreflang="en">Pharmacare</a></div> <div class="field__item"><a href="/news/tags/medicine" hreflang="en">Medicine</a></div> <div class="field__item"><a href="/news/tags/health" hreflang="en">Health</a></div> <div class="field__item"><a href="/news/tags/election-2015" hreflang="en">Election 2015</a></div> <div class="field__item"><a href="/news/tags/election" hreflang="en">Election</a></div> </div> <div class="field field--name-field-subheadline field--type-string-long field--label-above"> <div class="field__label">Subheadline</div> <div class="field__item">Pharmacare should be part of a seniors strategy, U of T experts say</div> </div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>While the main political parties are shying away from an evidence-based national seniors strategy that would include a country-wide pharmacare program to pay for prescription drugs, two U of T professors are passionately advocating for a plan on behalf of older Canadians.</p> <p>Dr. <strong>Samir Sinha</strong>, an assistant professor of medicine, and Dr. <strong>Danielle Martin</strong>, an assistant professor in the department of family and community medicine, are regular members of a CBC television news panel that discusses health care issues. Other members are Dr. <strong>Jacob Udell </strong>of the Faculty of Medicine and Dr. <strong>Peter Lin</strong>, who was the medical director at the Health and Wellness Centre at U of T Scarborough for seven years.</p> <p>When asked on air what the most important issue is in the federal election campaign, Sinha said a national seniors strategy. Martin's choice was pharmacare. The two are intertwined.</p> <p>In an interview with <em>U of T News</em>, Sinha explained the need for the national strategy. Martin responded via email to questions about pharmacare.</p> <h2 style="line-height: 21px; font-size: 19.99px;"><a href="http://news.utoronto.ca/tags/election">Read more Election 2015 coverage from&nbsp;<em>U of T News</em></a></h2> <p>Sinha, director of geriatrics at Mount Sinai Hospital, received a grant from the Canadian Institutes of Health Research (CIHR) to examine a national seniors strategy. He is also working with the Ontario government on seniors issues.</p> <p>“When you travel around the province you quickly realize that not enough is being done to meet the needs of an aging population, and not just in health care,” Sinha said. “Seniors are concerned about finances so they don’t age in poverty. They are concerned about community care, appropriate housing and transportation.”</p> <p>Ontario is implementing many of the reforms advocated by Sinha and organizations such as the Canadian Medical Association. But what is needed is a pan-Canadian approach.</p> <p>“This is not something each province can do on its own,” Sinha said. “We have to do this collectively as a country.”</p> <p>The federal government has taken a “hands-off” approach to health care, Sinha said. Whoever forms the next government could play a significant role not only in managing the Canada Pension Plan, the Old Age Security program and the Guaranteed Income Supplement but also take a leadership role in major infrastructure projects that would benefit seniors.</p> <p>Martin, vice-president of medical affairs and health systems solutions at Women’s College Hospital, said implementing a national pharmacare program “will require courage and some up-front investment to put in place the mechanisms to build a national formulary and engage in price negotiations with the pharmaceutical industry.”</p> <p>She noted that a recent poll showed that one in five Canadians – either themselves or someone in their household – had not taken medications as prescribed because of the cost. “In my practice, I see health conditions worsen over time when people do not take their medications.”</p> <p>The federal government and the provinces could commit to establishing a single-payer system within four years, she said, along with a publicly accountable body to administer it. “It’s completely doable.”</p> <p>The NDP announced a $2.6-billion, four-year program in support of a transition to a national pharmacare plan on Sept. 18. The federal government’s purchasing power would be used to negotiate better prices for drugs, which could save on average 30 per cent on prescriptions.</p> <p>The Liberal Party has “made vague statements about wanting to include pharmacare on a list of items to be negotiated with the provinces,” Martin said. “The Conservative Party has not yet articulated a policy on pharmacare, although the current minister of health [Rona Ambrose] has said the federal government would like to participate in bulk purchasing of drugs with the provinces.”</p> <p>The latest federal budget included income splitting and allowing people to put more money in Tax Free Savings Accounts (TFSAs). “It sounds really good politically,” Sinha said of these measures, “but from a policy standpoint it doesn’t address the fundamental issue of poverty for older Canadians. Many of them don’t have enough money to put much in TFSAs.”</p> <p>Sinha agrees with Martin that a new program would have to focus on “bulk buying” and the elimination of co-payments, which many seniors face when buying prescription drugs.</p> <p>“Co-payments do more harm than good,” Sinha said. “Many seniors simply choose not to fill their prescriptions because they can’t pay even low co-payments.” This in turn adds to health care costs.</p> <p>One of the reports produced through the CIHR grant concludes that while older Canadians account for 15 per cent of the overall population, they account for 60 per cent of the total spending within provincial and territorial medication programs. About 40 per cent of older Canadians are taking one inappropriate medication. An additional 12 per cent take multiple inappropriate medications.</p> <p>Sinha said the Liberals, the NDP and the Green Party are all generally supportive of a national seniors strategy. Nevertheless, he said, details are lacking.</p> <p>“We want to be non-partisan about this,” he added. “We just want to make sure that any program is based on the evidence and good policy.”</p> <p>Green Party Leader Elizabeth May has been the strongest advocate for a national seniors strategy, arguing that it needs to include not only a pharmacare plan but a policy to deal with dementia and Alzheimer’s and a respite program for caregivers.</p> <p>In Martin’s view it is&nbsp;the social determinants of health – income, education, employment, housing and food security – that shape our wellbeing. “Income in particular determines access to all of these other determinants of health,” he said. “A commitment to reducing or ending poverty is needed federally.”<br> &nbsp;</p> </div> <div class="field field--name-field-news-home-page-banner field--type-boolean field--label-above"> <div class="field__label">News home page banner</div> <div class="field__item">Off</div> </div> <div class="field field--name-field-picpath field--type-string field--label-above"> <div class="field__label">picpath</div> <div class="field__item">sites/default/files/2015-09-22-election-pharmacare.jpg</div> </div> Mon, 21 Sep 2015 16:49:15 +0000 sgupta 7294 at