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National Pharmacare is coming. What does that mean for pharmacy?

National pharmacare is nuanced, and the devil is in the details. What’s covered, who pays, and who administers the program all have significant implications on patients and pharmacies.
Sandra Hanna

Sandra Hanna will be presenting at Pharmacy U Vancouver.

We can all agree that all Canadians deserve equitable and affordable access to medications. As a pharmacist, this is my top priority. There is nothing more difficult than turning a patient away because they can’t afford their medication. So, national pharmacare sounds like a panacea for everyone, right?

Well, not so fast. 

National pharmacare is nuanced, and the devil is in the details. What’s covered, who pays, and who administers the program all have significant implications on patients and pharmacies. Consider existing drug coverage. Over 85 per cent of Canadians already have prescription drug coverage, through public and/or private plans. This current system might be complex, but Canadians agree that it works: 80 per cent are satisfied with their current primary plan, and three quarters of this group worry about the impact a national pharmacare program could have on their existing coverage; whether they’ll be forced to switch from reliable medications to alternate therapies, or even lose coverage entirely to a medication they’ve become reliant on if switched from a private to a public plan. This can be particularly disruptive, especially for patients with complex medication needs.

Pharmacy operators know that private formularies are more robust than public ones, and that funding for dispensing services from private plans is generally higher than public plans. While a single-payor publicly funded pharmacare program is estimated to increase prescription volumes by an estimated 1.3 per cent, the sector could correspondingly lose up to $1 Billion annually from reduced dispensing service funding. Despite tremendous strides in increased scope and service remuneration, our business model is still heavily reliant on funding for dispensing service to subsidize many of the other non-reimbursed patient services we provide. A single payor public pharmacare model puts these critical services at risk.

But un- and under-insured Canadians urgently need a pharmacare solution that fills the gaps in coverage; especially now, as Canadians are under considerable financial strain from skyrocketing inflation and interest rates. Instead of single payor publicly funded coverage for all, an effective pharmacare program should build on the existing – and working – mix of coverage to focus on those most in need.

We can make that happen now.

The federal Liberal government has already committed to improving access to prescription medications and has agreed to work with the NDP to introduce a Canada Pharmacare Act by the end of 2023. While the government has committed to universal pharmacare, details are currently light – and how we achieve universal pharmacare (i.e. coverage for all) has yet to be defined. A window of opportunity exists right now for the pharmacy sector to be part of the coming pharmacare solution.

We can help the government “Complete the Plan” for all Canadians. Rather than pursue a single-payor national pharmacare program, Complete the Plan urges the federal government to take leadership through a set of guiding principles promoting transparency and equity. It also promotes sustainable federal funding to provinces/territories to improve coverage for all Canadians – regardless of where they live. Complete the Plan demonstrates that we can achieve universal coverage for all Canadians without overhauling every drug program in the country; allowing government funds to be invested in other priority areas. By Completing the Plan we can set a high bar for drug coverage in Canada – and maintain existing medication coverage for millions of Canadians.

Every Canadian should have access to the medications they need and the choice to maintain their existing drug coverage. Ensuring universal access by building on, rather than replacing, existing coverage will minimize disruption. All providers – governments, pharmacies, insurers, employers and all of us as taxpayers and patients ourselves – have a role to play in ensuring medication access for all. Find out how you can be part of the solution.

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