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CANADIAN LIFE AND HEALTH INSURANCE ASSOCIATION SUBMITS ITS APPROACH TO THE ADVISORY COUNCIL ON THE IMPLEMENTATION OF PHARMACARE


News Release

Release Date: 10/03/2018
Staff Reference: Susan Murray; Wendy Hope

Toronto, October 3, 2018 -- Today, the Canadian Life and Health Insurance Association (CLHIA) published its submission to the Government of Canada’s Advisory Council on the Implementation of National Pharmacare as part of its consultation process. The Council, created through Budget 2018 and chaired by former Ontario Minister of Health and Long-Term Care Dr. Eric Hoskins, has been mandated with leading a national dialogue on how to implement affordable national pharmacare.

“Canada’s life and health insurers welcome the opportunity to improve the prescription drug system in Canada and support fundamental reform,” said Stephen Frank, President and CEO, CLHIA. “Canadians should have access to affordable medicine regardless of where they live across the country. We support reform that is affordable, achievable and protects the workplace benefit plans that Canadians value. Working in partnership with governments, our industry is ready to do its part to help shape reform”.

More than 25 million Canadians access prescription medicines today through their health benefit plans. There is a lot at stake for Canada to get reform right. Recent research indicates that moving away from a workplace plan to a public plan would result in more than 7.7 million Canadians being at risk of losing access to medications they take today. Canadians with depression, diabetes, cancer and pain issues would be most at risk of losing access to much needed medication.

The life and health insurance industry is advocating for significant, comprehensive reform to Canada's pharmacare system. The submission asserts that merely “filling the gaps” will not adequately address overall access issues, drive down costs for drugs or create a financially sustainable model for responsibly managing nationalized coverage.

“We recognize the government’s ambition on this project and applaud their goal of ensuring prescription medication is firmly within the reach of all Canadians,” Frank continued. “We look forward to the next steps in the Advisory Council process and to continuing to work together with Governments to improve Canada’s prescription drug system.”

About the CLHIA

The CLHIA is a voluntary association whose member companies account for 99% of Canada’s life and health insurance business. The industry provides a wide range of financial security products such as life insurance, annuities (including RRSPs, RRIFs and pensions) and supplementary health insurance to more than 29 million Canadians. It also holds over $860 billion in assets in Canada and employs more than 155,000 Canadians.

For more information:

Susan Murray, Vice President, Government Relations and Policy
(613) 691-6002/smurray@clhia.ca

Wendy Hope, Vice President, External Relations
(613) 691-6001/whope@clhia.ca



BACKGROUNDER: WORKING COLLABORATIVELY TO ENSURE EVERY CANADIAN HAS ACCESS TO THEIR NEEDED MEDICATIONS

All Canadians should have access to affordable prescription medicines regardless of where they live across the country. As a key player in the prescription drug system in Canada, the life and health insurance 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 address access issues as well as the cost and financial sustainability of the system. In order to achieve this, 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.

The industry believes that there are three key elements that any reform of the prescription drug system should embody.

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 benefit 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.

We know that Canadians highly value their workplace health benefit plans. In fact, 87% of Canadians surveyed said they place a great deal or quite a bit of value on their benefit plans1. Employers also place a great deal of value on benefit plans to attract and retain employees; offer access to a wide range of medications; mental health supports; and other wellness services.

Canadians do not want to put these benefits at risk. 93% of individuals surveyed said that government should help those who need help without hurting those already covered by good health benefit plans2.

Poorly designed reform, could put millions of Canadians existing coverage at risk. More than 7.7 million Canadians are taking medications that are not currently listed on their respective provincial drug plans. If drug coverage were nationalized, and private plans were no longer sustainable, individuals’ access to their needed medications could be at risk. Research illustrated that those with depression, diabetes, cancer and pain issues would be most at risk.

Providing drug coverage for everyone

Canadians should be able to access prescription medications regardless of where they live. To ensure access a common minimum standard national formulary could be established. The minimum standard formulary would apply to all plans (whether government run or private) and must be comprehensive enough to address coverage of drugs that treat both chronic illnesses and drugs for rare diseases

To reduce out of pocket costs, governments could establish a plan design framework that would not only include a minimum standard formulary but also set reasonable out-of-pocket limits for Canadians, possibly tied to income, so that any co-payments or deductibles are not a barrier to access.

Finally, it is important to acknowledge that certain regions and employers in Canada have a greater fiscal capacity to cover medications than others. To ensure that all Canadians can equally benefit from the standard formulary and out-of-pocket limits, some form of national risk sharing model for all payers (both private and public) for high-cost drugs should be included in any solution.

Ensuring affordability for consumers and taxpayers

Canadians pay some of the highest prices in the world for their medications. Canada should follow the lead of other developed countries that pool their full buying power in order to negotiate lower prices directly with drug manufacturers. This could be accomplished by having the pCPA negotiate on behalf of all Canadians to get the best prices possible. This does not require reform and can be achieved under the current system.

Further information on the industry’s views can be found in the CLHIA submission to the Advisory Council on the Implementation of National Pharmacare.

1 Based on a survey of 3,000 individual Canadians conducted by Abacus Data in March 2018.
2 Based on a survey of 3,000 individual Canadians conducted by Abacus Data in March 2018.