This is the second in Global’s three-part series on national Pharmacare as an issue in the federal campaign. Stay tuned as parties continue to release full platforms, statements and ideas in the lead up to October 19th.
While balanced budgets and financial standing have dominated the debate in the federal campaign thus far, healthcare – specifically the idea of national Pharmacare – hasn’t been a major issue. As we first noted in a September blog post, the issue briefly hinted at when Liberal Leader Justin Trudeau replied to a letter on the matter from the Council of the Federation, the group of Canadian premiers tasked with interprovincial collaboration.
Since then parties have slowly rolled out vague promises for prescription drug issues as we get closer to Election Day.
National Pharmacare: missing in action
Unsurprisingly, none of the leading parties have proposed ‘true’ national Pharmacare; one cohesive first-dollar, single-payer system, as opposed to the provincially-based pan-Canadian model. Given the size and diversity in Canada, this is to be expected: in many cases, region-specific conditions and prevalence issues arise.
The existing made-in-Canada solution: the pan-Canadian Pharmaceutical Alliance (pCPA)
Prior to the 2015 campaign, the fact that Canadian provinces already cooperate on pharmaceutical negotiations was not a part of the federal pharmacare discussion. It was only within recent months that the provinces opened up the door to future federal participation, but they haven’t made any moves yet.
Established in 2010, the pCPA is made up of representatives from each provincial drug plan. pCPA members receive proposals from pharmaceutical companies, and act as a common negotiating body; the idea of bulk purchasing leads pCPA representatives to seek better deals for their products, and save provincial drug plans money on treatments they would be listing anyway.
As of August 2015, the provinces have completed 79 joint negotiations for pharmaceuticals; an additional 22 joint negotiations are underway, while the pCPA has recommended that 11 products be negotiated individually by the provinces, and another 32 were deemed unable to be negotiated collectively or individually at the provincial-territorial level.
pCPA has set up a physical office in Ontario, and is continuing to formalize processes and create efficiencies. It claims to have produced savings of $315 Million in combined savings annually as of December 2014. However, backlog is often an issue and there are numerous opportunities for pCPA to streamline its work, improve its processes and enhance process transparency.
What are the parties saying?
With less than three weeks until voters visit the polls, time is counting down for issues to be included in the mainstream debate. While the Green Party has pledged full national pharmacare, their relatively small presence in the mainstream isn’t enough to fully ignite the debate. However, the other three parties have made a few related promises.
While the Harper Conservatives have traditionally stayed away from the healthcare debate, they have been highlighting the fact that under Harper, the Canada Health Transfer has increased steadily since 2006. However, in dealing with Pharmacare, they have been less than enthusiastic; while they reiterate that health is a provincial responsibility, Health Minister Rona Ambrose has requested that the federal government be allowed to participate in the pCPA process.
While the Liberals were quick to pass a policy resolution to construct a formal national Pharmacare plan in 2013, their plan has not yet materialized. While yesterday’s Liberal health announcement referred to savings in prescription drugs through bulk purchasing, a formal plan was not announced – nor was a specific funding promise. Instead, they are focused on home care for Canada’s seniors and wider federal-provincial collaboration on transfer payments.
As noted in our NDP health platform summary last week, The NDP have made the biggest promise for pharmaceuticals thus far: a $2.6 billion pledge of new federal funding focused on universal coverage for prescription drugs. While this is short of a true national Pharmacare plan, Mulcair and his team have clearly made this a priority in the NDP platform.
Under Mulcair, the NDP would also spend an additional $80M for the federal government to participate in the pCPA. Under this increased collaboration, the NDP would also seek a 30% average reduction in the cost of prescription drugs to provinces – something that is expected to generate as much as $3 billion in savings through provincial drug programs.
What can we expect moving forward?
Given the stance of the parties, we can assume that the federal government will continue to seek participation in pCPA in some capacity. While the size and negotiating clout of the group may increase, it will not likely result in ‘true’ single-payer universal Pharmacare in the near term. With parties focused on budgets like never before, it may be a long time before this idea truly comes to fruition – if at all.