The argument for providing 'essential medicines' for free in Canada
Published Monday, February 27, 2017 12:01AM EST Last Updated Monday, February 27, 2017 1:48PM EST
Canada’s healthcare system should cover the cost of 117 essential medicines that account for nearly half of all prescriptions issued in the country, according to two researchers who say the move would save Canadians and drug plans more than $3 billion per year.
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A study by Dr. Nav Persaud of St. Michael’s Hospital in Toronto and Steve Morgan of the University of British Columbia was published Monday, in the Canadian Medical Association Journal.
“Universal pharmacare has been long-promised but undelivered in Canada, in part because of concerns about where to start,” Morgan, a professor in the UBC School of Population and Public Health, said in a statement. “We show that adding universal public coverage of essential medicines to the existing system of drug coverage in Canada is a significant and feasible step in the right direction.”
The large number of medications available in Canada poses a challenge for clinicians, said Persaud, a family doctor who led the project. For instance, the Ontario Drug Benefit’s official list of medications that may be prescribed – called a formulary – includes more than 3,800 drugs. Quebec’s lists more than 7,000.
“A short list of essential medications might make it easier for clinicians to prescribe the most effective, safe and appropriate medications for their patients,” Persaud said.
After a multi-step peer review process that included family doctors, nurse practitioners, pharmacists, specialists, literature searches and study by a panel of experts, the researchers identified a list of essential medicines. It includes drugs to treat infections, pain, diabetes, heart disease, depression, anaphylaxis, seizures, migraines, Parkinson’s disease, along with a range of drugs to combat blood, breathing and joint diseases.
Researchers found this list accounts for 44 per cent of all prescriptions written in 2015, and up to 77 per cent of all prescriptions when therapeutically similar medications were considered.
The list was checked by auditing the prescriptions issued by two Toronto family health teams over a year. Researchers found the list covered 91 per cent of the prescriptions at the inner-city clinic and 93 per cent at the suburban clinic. As well, 93 per cent of the inner-city patients and 96 per cent of the suburban patients had all, or all but one, of their medications covered by the list.
Persaud is now leading a clinical trial with patients in four family health teams in Ontario to compare the health outcomes and healthcare use of people who received the free essential medicines with those who did not.
About one in 10 Canadians cannot afford prescribed medications, says Persaud, and more than one in five reports that they, or someone in their household, had skipped doses or split pills or did not fill prescriptions at all in the last 12 months in order to save money.
“Access to medicines can be the difference between life and death,” said Persaud. “There are treatments for HIV and heart disease that save lives but only when they are in the hands of people who need them.”
The researchers propose that governments purchase the essential medicines in bulk for all of Canada, which they estimate would save patients and drug plans $4.3 billion per year while costing government only an additional $1.2 billion per year.
“A program of this kind is a feasible way of improving the overall health of Canadians while dramatically lowering drug costs,” said Morgan. “Other countries that do similar things pay 40 to 80 per cent less for these essential medicines.”
Persaud told CTV News Channel on Monday that part of the problem is that there are multiple payers for medication in Canada, such as public plans, private plans and those who pay out of pocket as opposed to a single-payer system.
“The government purchasing medications in bulk, for example, would be a single-payer system and there we would see huge savings in terms of the price we paid per pill,” he explained.
Persaud said this system could be considered a “first step” in developing a national pharmacare strategy that advocates have called for in the past. He said the reason why there are so many arguments in favour of a pharmacare program right now is because there are millions of people who can’t afford medications and a comprehensive system would reduce those costs and improve efficiencies.
More than 110 countries have an essential medicines list. Research from high-income countries with such lists has shown improved care, cost savings and more appropriate use of drugs.