Prescription drug coverage in Canada: a review of the economic, policy and political considerations for universal pharmacare

Abstract

BackgroundCanadians have long been proud of their universal health insurance system, which publicly funds the cost of physician visits and hospitalizations at the point of care. Prescription drugs however, have been subject to a patchwork of public and private coverage which is frequently inefficient and creates access barriers to necessary medicine for many Canadians.MethodsA narrative review was undertaken to understand the important economic, policy and political considerations regarding implementation of universal prescription drug access in Canada (pan-Canadian pharmacare). PubMed, SCOPUS and google scholar were searched for relevant citations. Citation trails were followed for additional information sources. Published books, public reports, press releases, policy papers, government webpages and other forms of gray literature were collected from iterative internet searches to provide a complete view of the current state on this topic.Main findingsRegarding health economics, all five of the reviewed pharmacare simulation models have shown reductions in annual prescription drug expenditure. However, differing policy and cost assumptions have resulted in a wide range of cost-saving estimates between models. In terms of policy, a single-payer, ‘first-dollar’ coverage model, using a minimum national formulary, is the model most frequently advocated by the academic community, healthcare professions and many public and patient groups. In contrast, a multi-payer, catastrophic ‘last-dollar’ coverage model, more similar to the current “patchwork” state of public and private coverage, is preferred by industry drug manufacturers and private health insurance companies. Primary concerns from the detractors of universal, single-payer, ‘first-dollar’ coverage are the financing required for its implementation and the access barriers that may be created for certain patient populations that are not majorly present in the current public-private payer mix.ConclusionCanada patiently awaits to see how the issue of prescription drug coverage will be resolved through the work of the Advisory Council on the Implementation of National Pharmacare. The overarching and ongoing discourse on policy and program implementation may be construed as a political debate informed by divergent public and private interests.Electronic supplementary materialThe online version of this article (10.1186/s40545-018-0154-x) contains supplementary material, which is available to authorized users.

Prescription medication nonadherence associated with food insecurity: a population-based cross-sectional study

“…Our results lend support to calls for a national pharmacare program, which could potentially reduce prevalence of cost-related nonadherence by providing universal prescription insurance. [35][36][37] However, as suggested by our finding that 564 (6.3%) of the 8943 insured adults in our sample reported cost-related nonadherence, the extent to which insurance mitigates cost-related nonadherence depends on the out-of-pocket expenditures required. The dose-response relation between food insecurity and cost-related nonadherence that we found suggests the need for greater reductioneven exemption -of out-of-pocket drug expenses among those experiencing more severe food insecurity.…”

Dental problems and chronic diseases in mentally ill homeless adults: a cross-sectional study

“…For example, in Canada, the majority of dental care services are provided by private clinics and funded by private insurance or out-of-pocket payments [62,63] and are therefore poorly accessible to lowincome and socially excluded people. Moreover, Canada is the only socioeconomically developed country that provides universal coverage for health care services but not for prescription drugs [62,64]. All of this contributes further to a high economic and comorbidity burden and health inequities for low-income people without private insurance.…”

Universal Pharmacare in Canada: A Prescription for Equity in Healthcare

“…Several empirical studies have demonstrated the financial hardships suffered by Canadians because of the uninsured costs of pharmaceutical drugs. 11,16,17 Even with brief periods of public attention in the past, the topic of pharmacare has remained relatively untouched by Canadian policy-makers because of a lack of electoral incentives and general concern over costs to be incurred by government 18,19 -despite robust cost proposals by Morgan and colleagues, 20,21 and Wolfson and Morgan. 22 Recently, however, pharmacare has become a central topic of public discussion and political discourse, which is demonstrated by its inclusion in the platforms of major political parties for the recent federal election and the establishment of the federal government's Advisory Council on the Implementation of National Pharmacare.…”