In support of universal pharmacare
3 May 2022
Dear Prime Minister, Deputy Prime Minister and Minister of Finance, and Minister of Health,
We are health professionals and experts in health care and public policy who are concerned, as you are, with the quality, equity, and sustainability of Canada’s health care system – particularly under strains caused by the COVID-19 pandemic. We appreciate your recent commitment to pass a Canada Pharmacare Act in 2023 and to develop a formulary and bulk purchasing plan for essential medicines by 2025; however, we are asking you to increase the pace and scope of your commitment to national pharmacare. Canadians should not have to wait for a universal and comprehensive public pharmacare program.
We are writing now because the pandemic has increased the urgent need for a pharmacare system that provides universal access to appropriately prescribed, affordably priced, and equitably financed medicines from coast to coast to coast. Yes, there are many problems in the health care system requiring immediate attention nationwide – problems in areas such as health human resources, long term care, mental health care, primary health care, and surgical wait times. But, with adequate federal funding, the universal, public pharmacare program you have promised will immediately improve access to necessary medicines across Canada while generating billions in savings that provinces, territories, households, and businesses could invest in other health priorities.
As you know, all nations are obligated to provide universal access to necessary medicines under international agreements on health and human rights—agreements that Canada champions and helped create. To fulfil this obligation, every high-income country with a universal, public health care system provides universal, public coverage of medically necessary prescription drugs – every such country except Canada, that is.
In Canada, universal public health insurance effectively ends as soon as a patient receives a prescription to fill. Although many Canadians have some prescription drug coverage through private or public drug plans, approximately one in five Canadians is either uninsured or under-insured for the medications they need. Inadequate prescription drug coverage affects Canadians in all provinces and at all income levels; however, low- and middle-income households, women, and racialized Canadians are least likely to have adequate medication coverage and most likely to skip prescriptions because of out-of-pocket costs.
Canada’s current patchwork of public or private drug plans also exposes households and businesses to considerable and inequitable financial risks, adds considerably to the administrative costs of prescriptions, and isolates the management of prescription drugs from other key components of Canadian Medicare. None of these things is good for the health of Canadians, the Canadian health care system, or the Canadian economy. All of these things are getting worse under health and economic strains caused by the pandemic.
Canadians deserve better.
Since the 1960s, five separate national commissions have recommended that medically necessary prescription drugs should be included in Canada’s universal, public health insurance system. They all recommended this because it is the most equitable and affordable way to fulfil our obligation to ensure universal access to necessary medicines in Canada. The latest of such reports – the 2019 report of the Advisory Council on the Implementation of National Pharmacare – provides your government sufficient detail to guide implementation, beginning with universal, public coverage of essential medications.
There is no need to delay. The moral and clinical case for universal prescription drug coverage is clear. The administrative infrastructure needed to run such a program exists. Further, government and academic studies estimate that a universal, public pharmacare program will save Canadians between $4 billion and $7 billion per year. That is enough savings to pay for 30 to 50 percent more primary health care providers across Canada. A national pharmacare system can achieve these savings – while increasing access to medicines across the country – because single-payer pharmacare systems negotiate the best prices on the global pharmaceutical market.
This is why we are asking you to implement universal pharmacare now: when planning a post-pandemic recovery for Canada, the choice isn’t pharmacare or other health system priorities. The choice is pharmacare and other priorities because pharmacare – and only pharmacare – can save the money needed to do the other things.
We know powerful interests in the pharmaceutical and insurance industries oppose the implementation of a universal, public pharmacare program because they profit from the status quo. These forces of opposition do not make national pharmacare the wrong policy for Canada. They simply increase the need for strong, principled leadership from you, the Government of Canada, at this critically important time in our history.
The universal, public pharmacare program you have promised Canadians is the right thing to do. As recommended by your Advisory Council, it should start now with a Pharmacare Act that embodies all five of the principles in the Canada Health Act:
Universality: all residents of Canada must be covered on equal terms and conditions;
Public administration: the plan must be publicly funded and administered;
Comprehensiveness: the plan must cover a broad range of safe, effective, evidence-based treatments as listed on a national formulary;
Accessibility: access to covered medicines must be based on medical need, not ability to pay;
Portability: benefits must be portable across provinces and territories when people travel or move.
Also as recommended by your Advisory Council, coverage under national pharmacare should begin now with universal coverage of essential medicines; and it should be expanded to become a comprehensive system of public drug coverage—like those integrated within the health care systems of comparable countries—by 2027.
Acting in these ways to realise the full promise and potential of national pharmacare now will immediately transform health care in Canada for the better while generating billions in savings needed to address other health system challenges. You can count on our support as you do so.
Yours sincerely,
More than 1,000 health professionals and experts in health care and public policy.