March 8, 2019 09:30
The advisory Council on the implementation of a canadian system of prescription drug insurance, which had been commissioned in June 2018 by the government of Justin Trudeau, announced on march 6 its preliminary report that was highly anticipated.
Produced following a series of consultations across the country to governments, insurers, pharmaceuticals, pharmacists, clinicians, and interested groups by the price and the accessibility of medicines, this report acknowledges that the costs of drugs are increasing at an unsustainable rate, and that, without reform, the system will soon be at the point of rupture. It does not, however, on a crucial issue : the future of canada’s system of prescription drug insurance will there be mixed as in Quebec or 100 % public and universal ?
A few days of the filing of the first notice of the Council, seven unions and quebec groups travelled to Ottawa to demand again the creation of a public plan and universal that would cover the whole of the population. In spite of this position, the Fédération des travailleurs du Québec (FTQ) remains open to the retention of group plans additional private companies that can afford them.
With the Exception of the United States, Canada is the only country in theOECD that has a public health plan, but does not have a drug insurance plan public. Quebec is the only province in canada to have such a plan, but it is hybrid and the State sharing the coverage with the private insurers. The establishment of a canadian system of prescription drug insurance could become a major issue in the federal election expected in the fall, but the form it might take is still unknown, and the report was made public on march 6, gives no indication.
The CSN, the FTQ, the Fédération interprofessionnelle de la santé (FIQ), theconsumers Union, the Centrale des syndicats du Québec , and several other organizations are strongly in favor of the creation of a drug insurance system in Canada to the extent that it is public and universal. They have reiterated on march 1, at Ottawa, on fears that the federal government is tempted to reproduce the mixed system of private-public-quebec launched in 1997, which they consider costly and inequitable. According to them, this formula has led to an explosion of costs and deep inequities, and Ottawa would be a serious mistake in wanting to reproduce the quebec model, even if it is the envy of several canadian provinces.
The cases in quebec
When Dr. Jean Rochon was launched the quebec pension plan 20 years ago, he had allowed provisionally, say the unions, the creation of a hybrid plan in which workers would be covered by private insurers. According to figures from the consumers Union, an association which has campaigned since 2009 for a single regime of universal and public, 43 % of the quebec population is insured by the public prescription drug insurance Plan (RGAM) and 57 % by private insurance plans collectively. It is therefore an extremely important market for insurers.
For the past few years, John Rochon has joined the camp of those calling for a single plan, public and universal. To the Union of consumers in 2014, he said : “It is no longer time to ask whether a regime entirely public drug insurance is relevant, but when it must be implanted “.
The explosion of the premiums
In Quebec, the costs of drug plans will increase at a rate of 5% to 8% per year for the past twenty years. With the result that even if all the citizens in Quebec are covered by one or the other of the two schemes, 12 % of those insured in the public system and 6 % of those insured by the group insurance plans of private would get not the medications they are prescribed because they do not have the financial means to do so.
Canada, argues Caroline Senneville, vice-president of the CSN, is one of the countries where the drugs are the most expensive in the world, a fact for which the advisory Council has just given reason. Quebecers spend on drugs a lot more than the citizens of other countries. While the median drug expenditure per capita is to 603 $ per year for the OECD countries, it is of $ 1,087 in Quebec.
Prescribed drug spending has reached nearly $ 9 billion each year in Quebec only. The dispensing fees will be much higher if they are charged to an insured by a private plan than the public plan, a situation that is denounced from all sides, sometimes even the pharmacists themselves, as we have heard, on march 5, the issuance of The Invoice.
Get a better balance of power
The unions allege that a single regime of universal and public, who would negotiate for all Quebecers would give the State a better balance of power in the face of the pharmaceutical and pharmacists and would allow him to obtain drugs at a lower cost. This price drop would also, according to the calculations of trade union, savings amounting to between 1 and 3 billion dollars, according to the list of drugs that would be covered or not.
The president of the FTQ; and Daniel Boyer, recalls that the former minister of Health, Gaétan Barrette, had obtained a $ 300 million savings by negotiating the price of the generic to the only public system in québec. After the establishment of a single public plan in New Zealand, says Caroline Senneville, CSN, the prices of some medicines have become ten times less expensive than they were.
The trade unions are, however, in the details, and do not venture to go on the coverage that would be offered in a public plan and universal in Quebec. They do not say whether the list of drugs paid by the State in such plan should be of the same level as that offered by private insurers, and which is currently superior to that of the public plan.
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…
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