“We Need a Plan”: pharmacare in Canada
To mark this past Labour Day, the Canadian Labour Congress (CLC) launched its “A Plan for Everyone” campaign urging the government to create a national pharmacare plan.
Canada remains the only country in the Global North that has a universal healthcare system, but lacks a complementary program to ensure all people across the country have access to prescriptions as part of their care. As it stands, 3.5 million people in Canada – that’s one in ten – can’t afford to fill their prescriptions. Some one-quarter of Canadian families don’t take their prescribed medication due to high costs.
The overlap between health and poverty is clear. The World Health Organization has called poverty the single largest determinant of health. Mirroring the growing income gap, the life expectancy gap in Canada does not appear to be abating – for example, a McMaster study found a 21-year life expectancy difference between the poorest and richest residents in Hamilton, Ontario. Other research has found that men in the wealthiest 20% of neighbourhoods in Canada live on average more than four years longer than men in the poorest 20% of neighbourhoods. StatsCan estimates that, in general, income inequality causes the premature death of 40,000 Canadians per year.
At present, for those who do not qualify for the limited provincial and territorial programs, access to pharmacare is dependent on supplemental insurance provided by employers. The CLC estimates that 8.4 million working Canadians don’t have prescription drug coverage, and those who do receive supplemental insurance through their workplace may be paying for their drug coverage in the form of lower wage, lose their coverage if they change jobs or are laid off, or be unable to access the drugs they need through their private insurance plan.
Additionally, access to medication varies from municipality to municipality. According to the Canadian Health Coalition (CHC), the public drug plans that currently include approximately 29 percent of the population are a patchwork of different provincial, territorial and federal plans that sometimes are exclusive to seniors and often still include fees, co-pays, and deductibles. Practically speaking, this means that the same out-of-hospital cancer treatment costs $0 in Nunavut, $3,000 in BC, and $20,000 in PEI.
This structure creates a network of healthcare that is piecemeal, and reinforces a system in which people who are living with low-incomes, precariously employment, or struggling with skyrocketing rents are left behind. That’s why groups like Canada Without Poverty, as part of the Dignity for All campaign, the Canadian Federation of Nurses Unions, and the CHC have been calling for a pharmacare plan to be implemented at the national level. It’s also why the 2017 Alternative Federal Budget called for $3-4 billion in funding for a pharmacare plan, including 10% of private expenditures on prescription drugs.
On top of addressing the gaps in Canada’s national healthcare system, the economic argument for a national drug plan is also obvious. A year’s supply of the same medication costs $15 in New Zealand as compared to $811 in Canada, in large part due to a lack of a pooled bargaining power in the market. With a national pharmacare plan, people in Canada could save between 10 percent and 42 percent, over $10 billion total, on total drug expenditures.
Critically, a national pharmacare strategy is part of Canada’s work to realize social and economic human rights obligations. Article 12 of the International Covenant of Economic, Social and Cultural Rights outlines how governments must take steps towards the realization of the highest attainable standard of physical and mental health for everyone. In a country with as sophisticated of a healthcare system as Canada with leading health research bodies, as well as advanced technology and medicine, that unquestionably includes consistent access to medication.
With more households struggling with more debt than ever before, the increasing frequency of precarious jobs that lack benefits, and an aging population, the affordability of healthcare will only increase as a concern on the minds of people in Canada. And with a staggering 91 percent of Canadians saying they are in favour of a national pharmacare plan, it is time for the federal government to step up and lead the way.
Laura Neidhart is the Development & Communications Coordinator for Canada Without Poverty.