Patchwork drug plans flout the foundations of medicare
Globe and Mail writer Andre Picard.
Ontario will soon have kiddie pharmacare – publicly funded drug coverage for everyone under the age of 25. It’s an interesting political gambit by a beleaguered Liberal government gearing up for a provincial election in June, 2018, but doesn’t bring us much closer to universal pharmacare.
Extending drug coverage to this demographic group should, however, prompt some serious discussion – in Ontario and elsewhere – about coverage of prescription medications. Under Canada’s 1950s-style medicare program, hospital and physician services are 100-per-cent publicly funded. The way everything else is funded – prescription drugs, psychological services, home care, long-term care, rehabilitation, dental care etc. – is all over the map. For example, almost 50 per cent of drug costs are funded through public treasuries, while it’s only about 5 per cent for dental services.
Prescription-drug coverage, in particular, is a dog’s breakfast. Only one province, Quebec, has universal prescription-drug coverage. It essentially makes drug coverage mandatory – meaning it is paid by employers, you can purchase coverage from the state-run plan or have it subsidized if you are low-income. But that program, introduced in 1997, has seen premiums soar in recent years, to the point where it is unaffordable for many.
All the other provinces and territories cover drugs for seniors and people on social assistance, but these programs have restrictions such as co-payments and deductibles that vary based on income. There is also a bevy of special programs for patients with rare disorders. And there are head-scratching rules: For example, in Nova Scotia, cancer drugs are covered if they are administered in hospital, but not if they are taken at home.
Ontario has seven (soon to be eight) distinct public drug plans. The flagship is the Ontario Drug Benefit Program, which covers more than 4,300 drugs for four million seniors and social-assistance recipients at a cost of more than $4-billion annually. There is also the Trillium Drug Program, which offers subsidies to people with high drug costs – meaning more than 3 per cent to 4 per cent of their after-tax income. Then there is the New Drug Funding Program, which pays for intravenous cancer drugs administered in hospitals; the Special Drugs Program, which covers medication for people with rare conditions like cystic fibrosis; the Inherited Metabolic Diseases Program, which pays for special foods and supplements; the respiratory syncytial virus (RSV) prophylaxis program, which pays for drugs to prevent RSV in high-risk children, most of whom are in remote First Nations communities; and the Visudyne Program, which pays for drugs that treat macular degeneration. There are also separate, federal programs for status Indians, refugees and prisoners.
Despite the number of state-funded programs, almost half of Canadians rely on private insurance for coverage, most of which is employer-based. No one really knows precisely how many people have no drug coverage, though it is estimated that roughly six million Canadians are uninsured or underinsured. In Ontario alone, one in four people between the ages of 25 and 64 do not have drug insurance, according to Health Quality Ontario.
They are left to pay for drugs out-of-pocket, or do without. They show up in the emergency room because they can’t afford a puffer for their child with asthma, or try to make a one-month supply of blood pressure medication last two months.
With many people now self-employed or working part-time or in precarious jobs with no benefits, the number of people struggling to pay their drug bills continues to grow. So the real question Ontario’s kiddie pharmacare plan raises is: If universal, first-dollar coverage is appropriate for those under 25, why isn’t it appropriate for everyone? Why do we have means tests, user fees and co-payments for seniors when they purchase prescriptions, but not when they go to the hospital or to the doctor?
What sense does it make to have public drug programs for those under 25 and over 65, but not for those between the ages of 25 and 64? Why do you get stiffed with big drug bills of you happen to have a condition that doesn’t have its own special program, like diabetes?
The underlying principle of universal medicare is that no one should be denied essential health care because of an inability to pay. Given the way we fund drugs in this country, we are flagrantly violating that principle every day. If we believe in equity, why do we continue to cover drugs in a way that is inherently inequitable? Pharmacare is essentially the unfinished business of medicare and extending it only to young people reminds us just how much remains to be done.