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Prescription drug insurance : the CLHIA sets out the objectives that the reform must be


Denis Méthot

8 March 2019 13:30

Photo : Freepik

The insurance industry believes that any reform of the drug insurance system in Canada must be based on three major objectives :

1) to Protect and enhance the group insurance plans private place, because they offer Canadians more choice and a broader scope of protection than the public plans

In addition to prescription medications, these plans provide to their beneficiaries a variety of other coverages, such as vision care, dental care, mental health resources and many other services.

2) Establishing the prescription drug insurance for all

All Canadians must be covered and have access to the medications they are prescribed, must be thecanadian Association of insurance companies of persons (CLHIA). The governments should establish a list of drugs that should be covered for all, either through the insurance plan of the employer for those who have it, either by the State, for those who do not. This list is based on scientific observations would include the drugs costly, and medications for rare diseases.

3) Ensure affordable prices for consumers and taxpayers

Two different visions of a national insurance scheme drugs compete. In the first, the governments “nationalisent” prescription drug insurance and pay directly all of the drugs in the first dollar. The second, conveyed by the insurance industry, is to undertake a structural reform of the hybrid system current. According to the insurers, the reform of the insurance model drugs public private current would reduce to a minimum the overall financial impact on the government and would have the potential to address the problems faced by the current systems.

The rise and interest in private plans

Some have the impression that the access to a system of private insurance is decreasing in Canada. The facts contradict this perception, ” says the CLHIA. The number of Canadians covered by an insurance plan at work has increased over the past 10 years, from 71% to 79 %.

Not only the number of uninsured would rise, but the attachment to their diet is extremely high. According to a survey of 3,000 Canadians by Abacus Data in 2018, 87 % of people surveyed said that they pay a lot or a great deal of importance to their group insurance plan. In addition, according to this survey, 66 % of employees indicated that they would probably or certainly their employer if he would put an end to the guarantees supplementary health insurance.

Sales tool for employers and unions

The group insurance plans are also a tool of attraction and sale for companies when they are seeking employees. To attract and retain employees, since the collective insurance schemes are an important element of the total compensation. Employers used to give employees access to medicines that do not appear on the public lists and support for mental health problems, who form the most important cause of disability in Canada.

They also serve to keep employees healthy, reduce absences and injuries, improve productivity, increase the satisfaction rate of staff and as a major asset in the negotiation of the collective agreements. Even in the middle of the quebec labour, it is recognized that the coverages offered by the group insurance plans use maps of sale in a period of recruiting to attract members belonging to a unit trade union to another trade union.

What is happening in Ontario

A survey conducted in Ontario in 2018 has revealed two-thirds of employers thought that the governments should support the group insurance plans at work. However, to the great concern of insurers, 30% of employers surveyed indicated that they would call into question the group insurance plan if the government provides prescription drug insurance, which is to say to the insurance industry that the introduction of a model drug to single payer managed by the State could jeopardize the individuals to access other health resources.

According to research by the Canadian Health Policy Institute, 479 new drugs approved by Health Canada between 2008 and 2017, 87 % were covered by at least one private plan compared with 45 % covered by at least one public plan. In addition, the private plans would take less time to deliver new drugs. The same study revealed that on average, private plans offer the new drug in a period of 142 days, compared to 449 days for the drug plans to the public.

More than 7.7 million Canadians are taking medicines that are not covered by the drug insurance plan of their province, points to the CPOMA. If we “nationalized” insurance medication, these people could lose access to the drugs they need, anticipates the Association. An assertion that it makes even if it can’t know in advance which drugs would be covered or not by a national system of universal and public, or by the provinces. But in the immediate future in Quebec, according to its figures, 19.6% of people take a drug that is not on the list in the public system.

According to the Association, the persons who would be most heavily affected by the transformation of the current regime in favour of a single regime of universal and public are those who suffer from depression, cancer, diabetes and pain issues. In total, she said, forcing all the citizens to join the public plan could lead to the withdrawal of more than $ 1 billion in drugs that are currently reimbursed by the system.

Protect and improve the schemes in place

In the end, the CLHIA believes that any reform of the drug insurance plan should protect and enhance the insurance plans in place and ensure coverage of prescription drug insurance to all and do so without imposing additional costs on taxpayers or employers. The association says it is ready to collaborate with the government of Quebec to reduce the cost of the medication. How ? By changing the way are traded the price of prescription drugs and making strategic alliances in the negotiations, said Lyne Duhaime, president of CLHIA Quebec.

“The public and private plans must work together to negotiate a single price, wishes to the president of the CLHIA Quebec. Regardless of the approach chosen, it is important that the government or the unions working in concert with the private sector insurers, to ensure that all Quebecers have access to the medications they need, and to address the issue of costs to be relatively high they face. “

The cost of drugs : a burden constant

The pressures keep piling on the benefits plans of the companies. The cost of drugs is one of the factors that explain this situation. Solutions exist, but the will to apply them does not follow… This issue is the one that made the printed edition of march 2019 Log the insurance, available exclusively to our subscribers starting on 19 march. Not to miss this exclusive folder and receive it in time your copy, make sure that your subscription is valid by Wednesday, march 13th !


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