The new drug innovations to treat Hepatitis C are both hugely exciting and hugely expensive, and they speak to the scope of the pressures we’re facing in today’s environment for prescription drugs.
The Canadian Liver Foundation is recommending that every citizen born between 1945 and 1975 be screened for Hepatitis C. It’s one of those diseases that often has no symptoms; of the 300,000 Canadians estimated as infected, less than half are aware that they have it.
The new drugs (Solvani and Hardony) to treat it are both more effective and have fewer side effects than old protocols. But they’re expensive. The estimated cost per person has been estimated at $100,000. If everyone were to have access, the total tab would be $30 billion. Meanwhile, the amount we currently spend on all prescription drugs is $23 billion.
Does the cure justify the cost? Today, one in ten Canadians can’t afford to fill their prescriptions. As provincial public plans have worked to reduce their drug costs, a significant share of the burden has been shifted to private drug plans, which cover about 60 percent of us through employers.
Solutions like mandatory generic prescriptions (when an option), a retooling of drug formularies and adjusting the limits on our stop-loss pools would help, but ultimately, it may take a bigger, more comprehensive policy level fix.
Many say that would be Universal Pharmacare’s role, enacting a series of reforms that would significantly improve and extend Canadian healthcare. A comprehensive overview of what this could look like was published last summer – Pharmacare 2020 – by the Pharmaceutical Policy Research Collaboration.
With a target implementation date of 2020, the report presented four key policies as the platform of a universal health plan:
- Provide universal coverage of selected medicines at little or no direct cost to patients through Pharmacare.
- Select and finance medically necessary prescription drugs at a population level without needs-based charges (deductibles, coinsurance, or risk-rated premiums) on individuals or plan sponsors.
- Manage Pharmacare through a publicly accountable body that predicates decisions on drug coverage, prescribing and patient follow-up on the best available data and evidence.
- Establish Pharmacare as a single-payer system with a publicly accountable management agency to secure the best health outcomes for Canadians from a transparent drug budget.
Pharmacare 2020 projected that a universal drug plan will save the private sector up to $10 billion. It also suggested that the federal government’s share of program costs could be generated through corporate and income taxes and/or premiums – but should be new funds for the program and not funds taken from the existing transfers for hospital and medical care.
It’s all very ambitious and, not surprisingly, it has as many detractors as it does supporters. The Canadian Health Policy Institute, for one, published its own study earlier this year, “Pharmacare: what are the costs for patients and taxpayers?”
Ultimately, as the institute’s CEO and study co-author Brett J. Skinner put it: “The real problem with drug insurance in Canada is that public plans are under-insuring patients compared to the coverage provided by private plans. Public drug plans simply provide many fewer treatment options for patients. A national pharmacare monopoly would impose this inferior coverage on all Canadians.”
The fact is that 2020 is just around the corner and the issue of prescription drug costs and the burden of paying for them is not going away. The concept of universal pharmacare was first proposed by Supreme Court Justice Emmett Hall when he was chair of the 1964 Royal Commission on Health Services.
We can’t afford for it to take another 52 years to become a reality.