Pharmaceutical policies in Canada: reimbursement and disparities

Pharmaceutical policies in Canada are set at both the federal and provincial levels of government. The federal government is responsible for manufacturers’ intellectual property rights (patents), the initial approval and labeling of prescription drugs, and ensuring overall market competitiveness. On the other hand, the provincial government has jurisdiction over funding all healthcare services, including pharmaceuticals.

One of the key issues in Canadian pharmacy policies is the impact of pharmaceutical rebates on patients’ drug expenditures. The landscape of drug pricing in Canada is complicated, and the variable impact of refunds on patients’ drug costs is a significant factor. The cost of prescription and over-the-counter medications represents an increasing proportion of total healthcare expenditures in Canada. Compared to other OECD countries, Canada still needs to successfully control the increase in healthcare expenditures, particularly pharmaceutical costs. Factors contributing to high drug costs include increased per capita drug use, more expensive drugs, and rising prices of existing drugs.

There are also disparities in public reimbursement of orphan drugs in Canadian provinces compared to European countries. Orphan drugs are medications used to treat rare diseases, and the lack of consistent reimbursement policies across areas can result in inequitable access to these drugs for patients in need.

The future of pharmaceutical policy in Canada involves the need for a national strategy to ensure universal access to necessary healthcare, including prescription drugs. A coordinated approach between federal, provincial, and territorial governments is essential to promote equitable and sustainable improvements in the health of Canadians. The Council has made recommendations for what national pharmacare should look like in Canada, emphasizing the importance of addressing disparities in pharmaceutical policies.

Reimbursement of Drug Expenses in Canada

The reimbursement of drug expenses in Canada is a complex and multifaceted issue. Here are some key points regarding the refund of drug expenses in Canada:

• Prescription Drug Plans: Canada has various prescription drug plans that vary by province. Each province has a program that determines the coverage and reimbursement of prescription drugs for its residents. These plans can differ regarding the drugs covered, the reimbursement level, and the eligibility criteria.
• Pharmaceutical Rebates: Pharmaceutical rebates play a significant role in determining patients’ drug expenditures in Canada. These rebates are negotiated between pharmaceutical manufacturers and public and private drug plans. The impact of refunds on patients’ drug costs can vary, and the landscape of drug pricing in Canada is complicated.
• Public and Private Financing: Public plans provide 42% of financing for prescription drugs in Canada, while private drug insurance covers 35% of expenditures. Over 60% of Canadians have private drug insurance, mainly through their employer. However, more coverage still needs to be, resulting in inequitable access to prescription medicines.
• Affordability and Sustainability: Canada faces challenges related to the affordability and sustainability of pharmaceutical policies. The country has relatively high out-of-pocket expenditure for prescription drugs, which accounts for 19% of spending. The high cost of rare disease drugs further drives affordability issues.

National Strategy for Pharmaceutical Policy in Canada

A national strategy for pharmaceutical policy in Canada is seen as necessary to fulfill the country’s obligation to ensure universal access to essential healthcare, including prescription drugs. In the past, the lack of a clear vision, logical planning, and commitment from federal and provincial governments has resulted in poor system performance and uncoordinated pharmaceutical policies. Therefore, there is a need for a renewed national strategy that coordinates the pharmaceutical policies of federal, provincial, and territorial governments around a core health-focused goal.

• The framework for a renewed national strategy for pharmaceutical policy proposes policy actions on four core objectives that support the overarching health goal. These objectives include:
• National Consistency in Coverage for Drugs for Rare Diseases: The national strategy seeks consistency in coverage for drugs used to treat rare diseases nationwide. This is important to ensure equitable access to these drugs for needy patients.
• Support for Patient Outcomes and System Sustainability: The strategy emphasizes the importance of supporting patient outcomes and ensuring the sustainability of the healthcare system. This includes considering the cost-effectiveness of pharmaceutical interventions and promoting evidence-based decision-making.

Challenges in Prescription Drug Coverage in Canada

Challenges in prescription drug coverage in Canada include:

• Varied Patient Costs: There is a current context of various patient costs across the country, with many Canadians unable to afford their medications. This creates disparities in access to prescription drugs and can lead to inequitable healthcare outcomes.
• Lack of Universal Coverage: Unlike Canada’s universal Medicare system for hospital and physician services, prescription drugs are not universally covered. The method of prescription drug coverage in Canada involves a complex and largely uncoordinated mix of public and private insurance plans. Each province offers some form of public subsidy for prescription drugs, but there are no national standards for public drug programs.
• Gaps in Coverage: The “patchwork” system of private and public drug coverage in Canada leaves approximately one in five Canadians reporting no coverage for their prescriptions. This lack of coverage can result in financial barriers to accessing necessary medications.

Conclusion

In conclusion, Canadian pharmacy policies are complex and involve both federal and provincial governments. The impact of pharmaceutical rebates on patients’ drug expenditures and disparities in reimbursement of orphan drugs are significant issues. Canada faces challenges related to the affordability and sustainability of pharmaceutical policies. Addressing these issues and ensuring equitable access to necessary healthcare, including prescription drugs, are critical challenges for Canada’s future of pharmaceutical policy. A national strategy for pharmaceutical policy is seen as essential to ensure universal access to necessary healthcare, including prescription drugs. Coordinated approaches to drug pricing and reimbursement and addressing gaps in coverage and affordability issues are vital areas that must be addressed. The implementation of such a strategy can help address the challenges and disparities in pharmaceutical policies in Canada.