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Under the Canada Health Act. › services › health-care-system › pharmaceuticals › access-i.

Morgan et al. A study comparing 10 developed nations lend further support to these findings, showing that countries utilising single-payer models with evidence-based drug coverage criteria had lower average drug expenditures over countries with multiple payers [ 36 ]. The most recent iteration of a universal pharmacare proposal from Morgan and Gagnon et al. Contending the findings of Morgan et al. PCDI instead favor an approach where coverage is expanded for the under-insured population who currently lack equitable drug access, while maintaining the public-private insurer mix.

However, given the commissioned nature of this report canxda its seemingly unverifiable methodology, it is best understood in the broader political context as informed by external stakeholder interests.

Perhaps the most canada prescription drugs report so far on the costs and economic outlook of pan-Canadian pharmacare comes from canada prescription drugs parliamentary budget officer of Preescription [ 18 ].

This was an important finding from government because it is largely in accordance with prrescription estimates from the academic community involved in health economic policy research i. Furthermore, the transparent methodology and reporting was accompanied by an exploration of various assumptions through sensitivity analysis. Although, the sensitivity analysis demonstrated the volatility of estimates under varying model assumptions. As Canada considers implementing some pprescription of universal prescription drug coverage, there are several logical issues to consider.

The Daily — Prescription medication use among Canadian adults, to

Among the most important policy questions are which drugs would be covered, who will be covered, what level of coverage will be offered, and who will administer the program? A system of universal drug coverage for Canada requires, first and foremost, the determination of durgs medicines that every Canadian will have coverage for.

This will require a national formulary, a common list of eligible drugs for coverage, with or without additional drug-specific coverage criteria, that defines the minimum benefits that all Canadians would be entitled camada. The areas where there is already agreement among the provincial public drug plans in Canada may source the starting point for a national formulary under a universal pharmacare program.

This idea of canada prescription drugs minimum standard has been mentioned in some policy documents, including the report of the Standing Committee on Health [ 9 ]. If the national formulary was only to comprise an essential medicines list, it would be likely that most provinces would add canada prescription drugs it. However, it is possible that a comprehensive national formulary would include more drugs than some provinces currently provide prescriptipn for, making coverage beyond that list unlikely.

Whether the national formulary is to be comprehensive or narrow, it would likely be created by way of cxnada of existing health technology assessment processes at the Canadian Agency for Drugs and Technologies in Health and the price negotiation processes of the pan-Canadian Prescriphion Alliance.

The former agency provides formulary listing recommendations to provincial members of the latter, in the form of clinical and cost-effectiveness assessments, via their Common Drug Review and pan-Canadian Oncology Drug Review services [ 5152 ].

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However, currently the individual provincial policymakers are under no obligation to accept the recommendations coming prescruption reviews of the Canadian Agency for Drugs and Technologies in Health. A recent high-level government advisory committee has recommended that the roles and responsibilities of such pan-Canadian agencies be aligned with the vision of creating and maintaining an evidence-based national formulary for a universal pharmacare program for Canada [ 53 ].

Precription would not necessarily increase public administration costs nor necessarily preclude agencies from doing some technology assessment and canada prescription drugs negotiations for consideration on a case-by-case and province-by-province basis. Thus, the precedent that has long been established by the Canada Health Act is probably the best indicator for predicting who would be covered. However, the question remains as to how the policy framework would be resolved to address the status of other persons residing in Canada such as refugees, permanent residency applicants, extended travellers and undocumented persons.

As such, it would be unexpected for any future pharmacare plan to exclude permanent residents as this would be an unequal extension of the already existent universal canaca. Likewise, for those not meeting permanent resident status, the benefits that fall temporarily under the Interim Federal Health Program which are very similar to coverage for citizens may be extended and re-organized to reflect any new, universal pharmacare program [ 55 ].

This is in accordance with the principles of the Canada Health Actwhich provinces are obliged to canada prescription drugs to if they wish to receive federal government funding in the form of the federal health transfer [ 56 ]. Several commissions and government reports have recommended that a national formulary of medicines be added to the Canada Health Actwhich would appear to imply that similar prohibitions on prescription user-charges would apply [ 6789 ].

At the other extreme in terms of benefit designs under universal pharmacare would be to set the national standard at the level of catastrophic coverage against high costs. This may result in an increase or decrease in what patients already must pay depending on their province of residence and the agreed upon national threshold.

Last-dollar coverage is, however, appealing canadaa industry interests, which could reduce the political costs of program implementation.

Drug manufacturers prefer this model of coverage because it makes the government plan a payer of last resort only, rather than the single-payer for covered drugs. Under those circumstances, a majority of drug purchases by a majority of patients will be below deductible, meaning the patients prewcription have to pay for them whether they are on the national formulary or not.

This diminishes the negotiating power of the public plan because it reduces the impact on demand of a positive formulary listing [ 58 ]. A final consideration is who will administer universal pharmacare? There are two dimensions to this question in the Canadian federation.

First, will the program be run as a public program or will private insurers be providers of the pharmacare plan? Second, will the public portion of the program be provincially or federally administered? This is a form of complementary private insurance wherein the core, universal benefit of protection against catastrophic drug costs would remain a public responsibility.

Administration costs would therefore likely remain as they are in both the private and public sector; higher in the private than public sphere [ 59 ]. Also, purchasing power would likely remain fragmented and therefore limited by comparison to a single-payer system.

If universal pharmacare in Canada is to be a more comprehensive benefit for medicines on the national formulary, it is possible that such a program could be a single-payer public plan for such medications or a mandatory private plan for such medications. Universal drug coverage can be achieved in a manner like Quebec has had since In their system, private insurers are the primary providers of drug benefits in the sense that all employees who qualify for private insurance for prescription drugs as part of their compensation packages must have such private insurance.

This program limited the public sector cost of implementing universal drug coverage; however, it also limited both incentives and capacity for cost control, which has resulted in far higher prescription drug costs canada prescription drugs Quebec than in the rest of Canada [ 15 ].

If pharmacare is to be implemented as a single-payer system for drugs on a national formulary, such a system will have significant canada prescription drugs power and superior administrative efficiency [ 383959 ]. It also has the benefit of achieving greater equity and efficiency in revenue collection, which can come from changes to existing sources of canada prescription drugs general revenues such as incremental increases in personal and corporate income taxes.

These are among the reasons that a single-payer model has been recommended by major commissions and government committees. Under such circumstances, private insurance would likely remain for individuals who wished to have choices beyond the drugs listed on the national formulary, and possibly for canada prescription drugs who wished to have pre-payment plans for the co-payments or co-insurance that the universal public benefit might still have.

Even if there is to be a single-payer, public model of pharmacare for the drugs on a national formulary, a final question would remain: would the program be run by provinces or by the federal government. Because the Canadian Constitution Actin conjunction with the Canada Health Actcanada prescription drugs provinces primary responsibility for matters related to health care administration, it is likely that universal pharmacare would be run by individual provinces but held to national standards established by federal legislation.

This legislation would define the terms by which it would grant funding to support the pharmacare program s. As an aside, how the pharmacare framework is legislatively enacted, be it through changes to the existing Canada Health Act or by the drafting of a new statute is an important topic, but one that goes beyond the scope of our review.

For the interested reader, this legislative issue has recently been taken up in detail elsewhere [ 60 ]. Regardless of the legislative operationalization of the policy framework, universal pharmacare, under the aforementioned assumptions, would be tantamount to how Canadian medicare is run and could be a viable option if the federal government was willing to put sufficient funding into the system.

Political considerations are therefore paramount at this point in the policy development cycle. To what extent is the promise of a universal pharmacare program something that will help the current federal government get re-elected or an canada prescription drugs party elected?

As this is a major health care issue, an important political consideration is the support or opposition from health professional groups, health charities, industry and patient organizations. Among professionals, physicians and nurses have become increasingly vocal advocates for a universal, comprehensive pharmacare program. The most vocal physicians have been the members of Canadian Doctors for Medicare, an organization that has actively campaigned for universal pharmacare on the grounds that such a program would increase access to medicines, improve patient outcomes, reduce administrative burden on physicians, and save money through bulk purchasing [ 3861 ].

The Canadian Medical Association has taken a more tentative stance, however, arguing that universal coverage is necessary but that it need not be comprehensive nor fully funded through public financing [ 62 ]. Nurses have canada prescription drugs been active in advocating for national canada prescription drugs [ 43 ]. Sincethe Canadian Federation of Nurses Unions have campaigned for universal pharmacare through a variety of organizational activities [ 39436364 ].

Their campaigning is based on similar logic as that of the Canadian Doctors for Medicare; however, the nurses unions enjoy the support of other nursing organizations, such as the Registered Nurses Association of Ontario, who have added their voice to the call for universal, comprehensive, public pharmacare [ 65 ].

On behalf of the pharmacy profession, the Canadian Pharmacists Association has been the leading voice in the pharmacare dialogue. They have regularly updated their views and recommendations on this issue over the years as the policy discourse has developed [ 6667686970 ]. In the past, they have commissioned an external report on pharmacare costing to assist in informing their economic position [ 41 ].

However, the Canadian Pharmacists Association has consistently advocated for reinvestment of cost-savings from potential lost dispensing fee revenue back into pharmacy business in the form of funding for clinical pharmacy services; an argument based on the cost-effectiveness of improved health outcomes resulting from pharmacist intervention [ 6769 ].

The conservative position of the Canadian Pharmacists Association may be reflective of the significant and precarious state imposed on pharmacy business from pharmaceutical market reform increasing drug genericization and provincial policy responses that have resulted in continue reading revenue from dispensing fees and product mark-ups.

Importantly, as payment mechanisms have always been dependent on provision of pharmaceuticals as the core service, there has been a somewhat silent struggle by pharmacists, largely unbeknownst to the public and other health professions, to rectify the smaller patchwork of clinical pharmacy service remuneration simultaneously with the drug coverage patchwork [ 72 ]. Nonetheless, this revenue-based concern is largely exempt for hospital pharmacists, who are not reliant on dispensing fees for their income.

Perhaps this explains why their representative organization, the Canadian Society for Hospital Pharmacists, has advocated instead for a universal pharmacare framework that appears closer to that of other healthcare groups in the nursing and medical professions [ 73 ].

A groundswell of major national public interest groups, consisting of diverse representation ranging from charities, advocacy organizations and academia to labour unions and retiree associations, have added their voices to the pharmacare debate in recent years. Nevertheless, the extent of their involvement and the content of their policy prescriptions have varied considerably. Other patient advocacy groups, such as the Canadian Organization for Rare Disorders, while in support of universal pharmacare in principle, have raised concerns about access limitations to expensive, rarely used agents that may ensue after program implementation [ 82 ].

These concerns stem justifiably from fear that a restricted minimum national formulary, nested in a single-payer model, may radically disrupt pre-existing financial support arrangements in the form canada prescription drugs private payer insurance.

In spite of the widespread support for universal pharmacare, there remains staunch opposition from some conservative political think tanks such as the Fraser Institute and the Taxpayers Federation [ 8384 ]. The interests of the Canadian pharmaceutical industry have been prominently represented by Innovative Medicines Canada, who represent more than 45 drug manufacturer members [ 85 ]. The motivating interest underlying this position is to maintain the ongoing operation of private insurance company formularies, which often cover patented drug products that are not eligible benefits under public plans.

The Canadian Life and Health Insurance Association, as the voice of private insurers, has been diligent in issuing press releases and responses to various reports and news developments related canada prescription drugs universal pharmacare [ 8889909192 ].

Echoing that of the pharmaceutical manufacturers, the insurance industry position canada prescription drugs strongly maintained that a universal pharmacare plan should co-exist with private third parties and not threaten the holdings of beneficiaries of private insurance [ 92 ].

After more than 60 years of recommendations from national commissions and government committees, Canada appears poised to implement some form of universal pharmacare, likely in the government mandate that would start after the federal election in late Many stakeholder groups, academic experts, and government committees have more or less agreed on many of the major framework characteristics. Namely, universal pharmacare in Canada would, ideally, involve a reasonably comprehensive, evidence-based national formulary that is covered by a single-payer public program involving limited direct charges to patients.

Private insurance would be a canada prescription drugs and complementary option for covering additional drug choices and prepaying any user charges that the universal public system may entail. The concept of a universal, single-payer pharmacare program in Canada looms as a significant threat to the interests of industry; private insurers and canada prescription drugs manufacturers who stand to lose the most from the program. Whether Canada moves forward on reforms will therefore depend on voter mobilization.

This will be influenced, in part, by the work of the Advisory Council on the Implementation of National Pharmacare. However, policy development will also depend on the balance of political power of groups involved in the sector. The stakeholders who stand to lose revenues and profits under a universal pharmacare program have more canada prescription drugs interests than those who stand to gain; as such, it is possible that those opposed to major policy reforms may be able to launch marketing campaigns that change the narrative in ways that may make it difficult for reforms to take place.

Time will tell. Soroka SN. Health Council of Canada. Google Scholar. Article Canada prescription drugs Google Scholar. The financial burden of out of pocket prescription drug expenses in Canada. Int J Heal Econ Manag. Article Google Scholar. Financial burden of household out-of-pocket expenditures for prescription drugs: cross-sectional analysis based on national survey data.

Open Med. Marchildon G. Canada: health system review. Health Syst Transit. PubMed Google Scholar. Government of Canada.

The Prescription Drug List is a list of medicinal ingredients that when found in a drug, require a .serp-item__passage{color:#} Health Canada publishes notices to inform stakeholders of consultations and amendments related to changes to the Prescription. Prescription drugs play an increasingly important role in Canadians' health and Canada's health care system. They save lives, prevent the spread of disease, improve the quality of life for many, and control pain and suffering.

Royal Commission on Health Services; Canada Health Action. Ottawa: Building on the Legacy; Building on Values. Ottawa; Here today, gone tomorrow: the issue attention cycle and national print media coverage of prescription drug financing in Canada. Health Policy New York. Morgan SG, Boothe K. Universal prescription drug coverage in Canada: long-promised yet undelivered.

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