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CLHIA Submission to Advisory Council on National Pharmacare


Release Date: 10/03/2018
Staff Reference: Susan Murray

EXECUTIVE SUMMARY

Canada’s life and health insurers are committed to working in partnership with federal, provincial, and territorial governments to ensure all Canadians have access to affordable prescription medicines. The work of the Advisory Council on the Implementation of National Pharmacare is an important opportunity to build understanding of the problems with our current system and propose changes that will protect and enhance existing benefit plan, ensure drug coverage for everyone, and ensure affordability for consumers and taxpayers.

Canada’s life and health insurers play an important role in providing prescription drug coverage to Canadians. Life and health insurers provide more than 25 million Canadians with access to a wide range of prescription drugs and other health supports through extended health care plans. As a key player in the system, the industry recognizes that real problems exist and that the time has come to take meaningful steps to make improvements for the benefit of all Canadians.

Improving the system requires more than simply “filling the gaps”. Rather, improvements must involve systemic reform to address access to medications, as well as the cost and financial sustainability of the system.

The industry believes that there are three key elements that any reform of the prescription drug system must embody. These include:

Protecting and enhancing existing benefit plans

Private health benefit plans provide more coverage and choice for Canadians compared to public coverage. Canadians use their health benefits plans to access a wide variety of health services, including prescription medicines, vision care, dental care, mental health supports and many other services. These services both help prevent illness and contribute to overall wellness for Canadians.

Providing drug coverage for everyone

Governments should ensure that all Canadians can access and afford the medicines they need so that no one is excluded from coverage and are able to take their needed medications as prescribed. To achieve this, governments should establish a list of the medicines that everyone should be covered for through workplace plans for those who have a plan, and by government for those who don't. This list of drugs would be based on scientific evidence and include expensive drugs and drugs for rare disorders.

Ensuring affordability for consumers and taxpayers

Generally, two approaches for pharmacare have been put forward. One is for governments to nationalize all drug coverage and pay for all drugs directly on a first dollar basis. The second is to build from our current mixed system and to implement smart structural reform. The fiscal implications of these approaches have dramatically different outcomes for governments. Building off the current mixed private-public pharmacare model would minimize the overall fiscal impact to government and has the potential to address the issues we are trying to fix.

Regardless of the approach, it is important that governments work collaboratively and with private insurers to meet the objectives of ensuring everyone has access to their needed medications and to address the relatively high costs faced by Canadians.