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Here’s what you need to know about the federal government’s Implementation of National Pharmacare report

On June 12th, the Advisory Council on the Implementation of National Pharmacare released their final report looking at the implementation of a national program to address the inequities that Canadians currently face when it comes to drug access. It outlines 60 recommendations, steps to implementation and key details on things like co-pay, budget costs, strategy for rare diseases, and impacts on patients and providers. Below, we’ve summarized these key details for you to better understand how this new plan for pharmacare would impact you and your family. You can download the full report here.

Recommendations:

The federal government would work with the provincial and territorial governments to establish universal, single-payer, public pharmacare in Canada to be set up similar to Medicare. By having a single-payer system, the council believes that increased bargaining power with pharmaceutical companies would result in lower drug prices.

The council recommends that national pharmacare be enacted through new legislation, embodying the five fundamental principles in the Canada Health Act:

  1. Universal
  2. Comprehensive
  3. Accessible
  4. Portable
  5. Public

Overview of Steps to Implementation:

While there are 60 recommendations outlined in the report; here are some of the high-level recommended steps to implement a pharmacare program in Canada. 

  1. Create a Canadian Drug Agency that’s governed collaboratively by the federal, provincial and territorial governments and would have patient representation on the board. This agency would also be responsible for providing guidance on the use of drugs and monitoring their safety and efficacy. The intent is to increase timely access to new medications.
  2. Create a national formulary that’s based on efficacy of the drugs and value for money.
  3. The initial formulary would be a list of essential medicines covering most major conditions and representing about half of all prescriptions. Over the subsequent five years, additional prescription drugs would be added to the national formulary as prices and supply arrangements are negotiated. The initial list of drugs would be available through national pharmacare beginning January 1, 2022. A full comprehensive formulary would be in place no later than January 1, 2027
  4. By January 2022, a detailed national strategy for funding and access to expensive drugs for rare diseases would be implemented.
  5. Provinces and territories would have to opt in to pharmacare by agreeing to the national standards and funding parameters. The recommendation is that the federal government pay for the incremental costs to provinces and territories for expanding coverage. It’s recommended that the federal government also reach out to First Nations, Inuit and Metis governments to determine how they may wish to participate in national pharmacare.

Proposed details that would directly impact Canadians:

Co-payments: The council recommends that drugs on the essential medicines list would carry a co-payment of $2, while all other drugs would have a $5 co-payment. People receiving social assistance, government disability benefits or the federal guaranteed income supplement benefit would be exempt from co-payments and no person or household would pay more than $100 per year.

Rare Diseases: The council is recommending that the federal government develop a national strategy for expensive drugs for rare diseases. It is also recommended that a national expert panel work with patients and clinicians to determine which rare disease drugs should be funded for which patients. This strategy would be in place beginning January 1, 2022.

Costs: It’s estimated that it will cost an additional $3.5 billion in 2022 to launch national pharmacare starting with universal coverage for the essential medicines list. It’s estimated that as the formulary increases that the annual costs will reach $15.3 billion in 2027. The council is proposing a new, dedicated fiscal transfer to support national pharmacare; it’s also recommended that this transfer is reviewed every five to ten years. Any changes to the key elements of pharmacare should require approval by the parliament of Canada and 70% of participating provinces and territories.

As governments work towards implementing national pharmacare, it’s important to ensure that current access challenges and inequities are addressed in a national formulary.  

Photo by The Tonik on Unsplash