Pharmacare Act opens the door for ‘fill-the-gaps’ care, experts argue in CMAJ commentary

With the Liberal government’s efforts to bring about a national pharmacare program underway, a new report argues Canada’s pharmacare legislation needs to change.Bill C-64, or the Pharmacare Act, enables the federal government to kickstart negotiations with the provinces and territories that would establish a publicly funded health insurance program to cover the cost of prescription drugs.But in a commentary published in the Canadian Medical Association Journal (CMAJ) on Monday, healthcare policy expert Steven Morgan and health lawyer Matthew Herder argue that the bill as it is currently written opens the door to a “fill-the-gaps” plan rather than a comprehensive universal pharmacare plan integrated into our healthcare system.“Our principal concern is that a national pharmacare program should be the kind of public policy that establishes strong and robust institutional capacity to manage very complex problems in what is the second largest component of healthcare that is the prescription drug segment of our healthcare system,” Morgan said in an interview with the Medical Post.In 2019, the Advisory Council on the Implementation of National Pharmacare called for a publicly administered universal and single-payer system rather than a mixed public-private system, arguing that a universal system would do more to lower drug prices and ensure fairness.And while the preamble of Bill C-64 points out that the advisory council has called for system that is “universal, single-payer, public,” Morgan points out that any mention of public administration of this program is missing from the main text of the bill.“In critical sections of the bill around the kind of program that would be created by it, they dropped the term ‘public,’” he explained.Some stakeholders, such as the Canadian Pharmacists Association, have called for a mixed public-private system for pharmacare, where private insurance coverage for prescription drugs can co-exist alongside the federal plan to ensure coverage for patients with existing private insurance policies wouldn’t be disrupted.However, Morgan warns that if the feds implement pharmacare as a mixed public-private system, similar to the way it implemented the Canadian Dental Care Plan, it will become “the U.S. healthcare system for prescription drugs in Canada.”“It will be fragmented. It will be largely privately run. It will increase costs. It will perpetuate premium-based financing, which puts middle- and low-income families at significant disadvantage, and it will inject profit motives into drug coverage decision making,” he said.In addition, Bill C-64 refers to the Canadian Drug Agency, which is a yet-to-be-established federal agency, set to be responsible for assessing prescription drugs and negotiating prices. The authors say the bill fails to officially establish the agency and does not set out its powers, functions and governance structures, which would “leave the agency vulnerable to interference, potentially toothless, and easily dismissible.”Bill C-64 is currently before the Senate and once it passes, the federal government will begin negotiations with the provinces and territories on the funding and implementation of the program—although Alberta and Quebec have already indicated that they intend to opt out of the program.

Pharmacare Act opens the door for ‘fill-the-gaps’ care, experts argue in CMAJ commentary

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