Federal pharmacare is a bomb waiting to detonate your coverage

If the New Democrats have their say, your drug insurance coverage could take a turn for the worse.

In their agreement to keep the federal Liberals in power, the New Democratic Party have asked for the adoption of a national single-payer universal drug insurance plan. While the idea of expanding insurance to all may have some merit, the formula the NDP and the Liberals have adopted could imperil the quality of coverage currently enjoyed by millions of Canadians.

What they’ve proposed is a plan, set out in the newly-tabled Bill C-64, that would cover birth control and diabetes medication country-wide in its first phase. Yet, the Liberals and the NDP have been clear that these two categories are just the first phase of a grander, universal single-payer pharmacare regime.

The problem with the plan is not its universality, but its single-payer aspect. The NDP hopes to lay the groundwork for the abolition of private drug insurance and its replacement by a single plan administered by the government.

Whichever province you reside in, private drug insurance plans, as a whole, cover many more different medications than public plans do. The difference varies by province, but on average, private coverage is 51 per cent more extensive than its public counterpart. In Quebec, where public insurance is more expansive than in any other province, private insurance covers 59.6 per cent more drugs.

Indeed, even if coverage similar to Quebec’s public drug insurance plan were to be extended across the country, the coverage quality of 21.5 million Canadians could be jeopardized if a government monopoly were to be imposed. And loss of coverage could mean loss of access to drugs.

Already, some pharmacists are raising the alarm about what reduced insurance coverage could signify. Alan Low, executive director of the Medicines Access Coalition, for instance, says that coverage by some form of insurance is often a key factor used by companies to determine whether a drug should be distributed in a given jurisdiction. This means that if a drug stops being covered by insurance in Canada, pharmaceutical companies may withdraw that drug from the country entirely.

When you consider that just under half of all new drugs entering the Canadian market over the past decade are covered by public plans, it’s enough to send a shiver up your spine!

In addition, Canada contends with the issue of approval delays. The regulatory process a new drug has to go through before it can be marketed is already long and costly. If a drug is approved by Health Canada, it takes an average of 226 days for a private insurer to approve its coverage. That’s a little over seven months.

That might seem long, but it’s nothing compared to coverage delays in public plans. On average, it takes 732 days after approval by Health Canada, or a little over three times as long, for a public plan to add a drug to its list of covered treatments.
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In other words, if an innovative drug is needed to treat whatever ailment you’re suffering, you better be patient if your only option is public insurance.

If federal politicians want to ensure that all Canadians have access to drug insurance, certain more targeted options would achieve this goal without jeopardizing the quality of coverage enjoyed by the majority.

At the moment, thanks to public and private drug insurance plans, just under 90 per cent of the Canadian population has drug insurance. That still leaves 4.9 million of our fellow citizens who, for a variety of reasons, have no insurance at all. Among these, the most vulnerable are surely the 1.1 million Canadians who are not eligible for any coverage, be it public or private.

A targeted program aimed at this latter category of citizens would have the benefit of improving their access to health care without jeopardizing the access of tens of millions of Canadians for whom the current system works much better.

With federal public finances being as tight as they are right now, an insurance program tailored to the most vulnerable would have the added benefit of not pumping up the deficit as much as a universal, single-payer program would.

Moreover, adopting an insurance mandate, as Quebec has done, would have the benefit of ensuring universal coverage, all while allowing people to choose between private and public insurance.

In its current form, however, the NDP’s envisioned pharmacare program presents a considerable risk to the insured. Let’s hope that other federal politicians will take a more responsible approach.

Emmanuelle B. Faubert est économiste à l’IEDM et l’auteure de « Les dangers d’un programme d’assurance médicaments pancanadien ». Elle signe ce texte à titre personnel.