National pharmacare in the age of COVID-19 and beyond.

TELUS Health Annual Conference 2020

COVID-19 has likely moved the payment model for a national pharmacare program firmly in the direction of a fill-the-gaps approach rather than a universal, single-payer model.

“This is probably the single biggest impact of COVID on the path for pharmacare in Canada,” said Michelle McLean, senior vice-president, health and wellness, Hill+Knowlton Strategies, during a live webinar on June 9 on the topic of pharmacare in the age of COVID-19, presented by TELUS Health. A full recording of the webinar is available below.

Before the pandemic, the federal government appeared to be moving more in the direction of a single-payer model, as recommended in 2019 by the federally appointed Advisory Council on the Implementation of a National Pharmacare. However, this was still open for debate, “even within the Liberal party. There was equal passion for a fill-the-gap model as there was for a universal single payer,” recalled McLean.

However, Canada’s ballooning deficit in response to COVID-19 has changed the conversation. “What we’re hearing in Ottawa is that the fill-the-gap camp now has an edge,” noted McLean. “It’s a real question whether the government still has the fiscal maneuverability to go to a universal single payer system.”

Having said that, any new policy or legislation that’s not directly related to COVID-19—whether to do with pharmacare, indigenous reconciliation or climate change—has been put on hold or delayed.

Related to pharmacare, the implementation of a new drug pricing framework by the Patented Medicine Prices Review Board (PMPRB), expected to happen on July 1, has been moved to January 1, 2021. This new framework will see lower prices for many drugs in Canada, considered key to improve Canadians’ access to needed medications.

“The PMPRB changes were positioned as foundational element for pharmacare,” said Bob Bell, who presented with McLean and was deputy minister of health in Ontario before joining Hill+Knowlton as an associate.

Even when the PMPRB changes go into effect, it may be some time before pharmacare resumes a prominent place on federal or provincial agendas. Other policy issues related directly to COVID-19 have come to take precedence, with long-term care at the forefront. “[COVID-19] has brought to light the fact that so many of our seniors…live in circumstances that simply don’t feel right in this day and age,” said Bell.

Other competing policy issues that are a direct result of COVID-19 include: improved emergency preparedness; improved public health data systems and analytics; mental health supports, already a growing area of investment before the crisis; home care supports, also already a growing area of investment; the imbedding of virtual care into public health systems; the clearing of backlogs throughout the healthcare system (surgeries, diagnostics, etc.); and, last but not least, deficit management.

When pharmacare eventually does work its way back up the priority list, Bell predicted that provinces will more likely support a stepwise approach, consistent with a fill-the-gaps model. This would likely start with the continued establishment of a Canadian Drug Agency (CDA). As announced before COVID-19, the CDA’s first three main tasks were lower drug prices (building on the new PMPRB framework and the work of the pan Canadian Pharmaceutical Alliance), an essential medications list and a national strategy for high-cost drugs for rare diseases.

“[These] are probably three elements where the federal government would lead in provincial negotiations to achieve a start to a pan-Canadian pharmacare,” noted Bell. “Certainly all provinces recognize the pCPA [pan Canadian Pharmaceutical Alliance] has improved their ability to negotiate with international pharma companies.”

During the webinar, Bell and McLean spoke in more detail about potential changes in federal-provincial relations pertaining to health care. See below for the complete recording of the webinar and to download the presentation.

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