Pharmaceutical Policy in Canada : Reflections on a Shifting Landscape

Centre forHEALTH SERVICES AND POLICY RESEARCH

Pharmaceutical Policy in Canada:Reflections on a Shifting Landscape

Steve Morgan, PhDCentre for Health Services and Policy Research

University of British Columbia

T H E

C O M M O N W E A L T H

F U N D

Centre forHEALTH SERVICES AND POLICY RESEARCH

Canadian “Medicare”

Centre forHEALTH SERVICES AND POLICY RESEARCH

Canadian Pharmacare

Centre forHEALTH SERVICES AND POLICY RESEARCH

The coverage landscape:Under- and Un-insured for Routine Drug Costs

0%

10%

20%

30%

40%

50%

CAN BC AB SK MB

ONQC NB NS PE NF

Uninsured Under Insured

Source: Applied Management (2000) "Canadians’ Access to Insurance for Prescription Medicines Volume 2”

Centre forHEALTH SERVICES AND POLICY RESEARCH

The coverage landscape: Under- and Un-insured for Catastrophic Costs

0%

10%

20%

30%

40%

50%

CAN BC AB SK MB ON

QC NB NS PE NF

Uninsured Under Insured

Source: Applied Management (2000) "Canadians’ Access to Insurance for Prescription Medicines Volume 2”

Centre forHEALTH SERVICES AND POLICY RESEARCH

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1933 1943 1953 1963 1973 1983 1993

Medical & Pharmaceutical Products Retail Rx

Drug Spending as % of GDP

The financial landscape

Source: CIHI and Statistics Canada

Centre forHEALTH SERVICES AND POLICY RESEARCH

The result, a national pastime…

Provincial Inquiries– New Brunswick– Saskatchewan– British Columbia

National Inquiries– Romanow– Kirby– National Forum on Health– House of Commons

Centre forHEALTH SERVICES AND POLICY RESEARCH

What has been recommend?

• National Standards for Coverage– First-dollar coverage for vulnerable

– Catastrophic coverage for all Canadians

– Disease management coverage

• National agency/network– Drug regulation

– Drug policy

– Outcomes and policy research

Centre forHEALTH SERVICES AND POLICY RESEARCH

What are policy makers seeing?

Centre forHEALTH SERVICES AND POLICY RESEARCH

The Shifting Landscape?

Centre forHEALTH SERVICES AND POLICY RESEARCH

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1933 1943 1953 1963 1973 1983 1993

Medical & Pharmaceutical Products Retail Rx

Drug Spending as % of GDP

The financial landscape

Source: CIHI and Statistics Canada

Centre forHEALTH SERVICES AND POLICY RESEARCH

The demographic landscape

Source: Statistics Canada

Centre forHEALTH SERVICES AND POLICY RESEARCH

What are policy makers doing?

Centre forHEALTH SERVICES AND POLICY RESEARCH

Coverage (…progress?)

• Provinces agreed to “reasonable coverage” against catastrophic drug costs

• At the same time…– BC eliminated seniors plan universal

income-based plan– Manitoba increased deductibles under its

income-based plan– Ontario backed down on income-based

plan (for now)

Centre forHEALTH SERVICES AND POLICY RESEARCH

Drug Cost Control (the good news)

• Common Drug Review– Coordinated HTA for new drugs– High standards of evidence (for now)– Provinces retain coverage-decisions

• Outcomes-Based Coverage– Now in BC, NS, MB, SK …

• Utilization Initiatives– Data NPDUIS– Analysis COMPUS– Provincial Agencies Quebec “Medicines Council”

Centre forHEALTH SERVICES AND POLICY RESEARCH

Thank you