First phase of pharmacare must not ‘create new gaps’ in existing coverage, say lobbyists

Legislation recently rolled out to create universal pharmacare in Canada came as a welcome step forward for some advocacy groups, but concerns about issues such as the make-up of the national drug formulary will form the basis of some lobbying activity as the bill progresses through the House.

“We need to make sure that by filling current gaps we don’t inadvertently create new gaps,” said Seema Nagpal, chief science officer of the Canadian Cardiovascular Society (CCS). “We all know that one in five Canadians currently don’t have insurance to cover the cost of prescription drugs. That’s what we’re trying to fix, but we don’t want to create another problem in trying to fix that one.”

Health Minister Mark Holland (Ajax, Ont.) introduced Bill C-64, the Pharmacare Act, on Feb. 29, outlining a proposed first phase towards implementation of national universal pharmacare to address accessibility and affordability of prescription drugs and related products in Canada.

If the bill is passed, Holland will begin negotiations with the provinces and territories for a funding commitment to provide universal, single-payer coverage for some diabetes medications and contraception. Along with the introduction of the bill, Health Canada also published the lists of diabetes medications and contraceptives that would be covered, following agreement by the provinces and territories.

Nagpal told The Hill Times that CCS is very supportive of a pharmacare program that will allow people to access medication they need, but added that a lot of questions remain.

The bill calls for the recently formed Canadian Drug Agency (CDA) to develop a national formulary or list of the pharmaceutical drugs that would be covered by the national pharmacare program. The CDA was announced on Dec. 18, 2023, and is built out of the former Canadian Agency for Drugs and Technologies in Health.

Which medications will make it onto the formulary is one of the big questions that will need to be addressed, according to Nagpal.

“Which drugs are restricted? Which drugs require prior authorization? All of these things matter because it provides extra steps to getting the medication, and places an administrative burden on the physician, “ she said. “Administrative burden is increasing in medicine right now, and places significant barriers to care. If a physician has to fill out multiple forms, [or] make multiple calls in order to get the medication reimbursed for their patients, it’s a barrier.”

Another important question relates to how co-payments will be handled under pharmacare, according to Nagpal.

Typically, when an insured person collects a prescription at the pharmacy, they’re required to pay either a flat fee, or a percentage of the prescription. The type of co-payment could affect who can afford to access their medication, according to Nagpal.

“If I make less money than you, for example, I may be able to have less of a co-pay, but if it’s a flat fee, maybe not,” she said. “These are details that we wouldn’t expect to know at this point. However, [those details] are significant in terms of making sure that people get access to the medications they need.”

According to the bill, the health minister would establish a committee of experts who would make recommendations on the operation and financing of the pharmacare program.

“Each and every Canadian should have access to the prescription drugs they need. That’s why we’re working with our partners towards the first phase of national universal pharmacare. This important next step will provide universal access to contraception and diabetes medication that will be transformational in improving health outcomes in Canada,” said Holland in a Health Canada press release.

Nagpal said the federal government will need to make sure that the right people are at the table to ensure that the evolution of pharmacare meets everyone’s needs going forward.

Monica Kocsmaros, chief external relations officer for the Juvenile Diabetes Research Foundation (JDRF), a non-profit organization funding type 1 diabetes research, told The Hill Times that Bill C-64 is “a good step in the right direction” to address a patchwork of coverage across Canada, but it is important to be certain that the final pharmacare plan will meet the needs of all Canadians.

“We really want to make sure that the list of insulins being covered is really what needs to be on that list, and that it meets the needs of those living with type 1,” she said. “What we’re seeing at the beginning are insulins … that are listed that are never or rarely used anymore. We’re seeing that the rapid-acting insulins are biosimilars—which is fine—but we don’t know if all of those biosimilars are approved for use in pumps,” she said. “It’s obviously not a one-size-fits-all approach. It’s a very personalized treatment plan that meets individual needs. And so one insulin, or one device, could work for someone but not somebody else. And so that patient choice piece, for us, is paramount in all of this.”

Kocsmaros said that the JDRF will begin lobbying the federal government regarding Bill C-64 following consultations and “due diligence with our community.”

“Our plan will be to reach out to them, and to make them aware of some of the gaps that we may be seeing in terms of that initial list, and how we can work together to make sure that the right insulins do end up being on a final formulary,” she said.

Separate from the bill, the federal government also announced plans to establish a fund that would support access to diabetes devices and supplies, according to a backgrounder document released by Health Canada. Further details about the fund will be provided following discussions with the provinces and territories, according to the document.

“Devices are obviously critical in the management of type 1 diabetes, especially given that it’s a lot of self-management almost all the time,” said Kocsmaros. “We want to see what that will look like … because we have been seeing a lot of provinces now increasing their public coverage of devices, [such as] advanced glucose monitors and insulin pumps. We just want to understand how this new fund will help fill any of those existing gaps.”

The JDRF is active on the federal lobbyists’ registry, and is represented by Jessica Diniz, the organization’s president and CEO, as well as by Kocsmaros and Luka Stevanovic, national director of government relations and advocacy.

Groups that are concerned about the pharmacare bill include Innovative Medicines Canada (IMC). David Renwick, IMC’s interim president, argued that Canadians should be concerned about how the proposed single-payer pharmacare model could potentially impact existing public and private drug coverage, in an IMC press release issued on Feb. 29. Because more than 97 per cent of Canadians are already eligible for some form of prescription drug coverage, the federal government should instead work toward filling the gaps in this system, according to the IMC press release.

“Moving provinces towards a single-payer system, where drug coverage could be reduced to the lowest common denominator, would limit patient access to new treatments. We also have questions about the growing role of the federal government in determining drug coverage, which is an area of provincial jurisdiction, and the potential cost at a time when our health-care system has other pressing funding priorities,” said Renwick in the press release.

The MEI, an independent public policy think tank with offices in Montreal and Calgary, argued that private drug insurance plans can offer better coverage than government plans, and requiring Canadians to switch to universal pharmacare could result in a drop in insurance quality for many, according to a Feb. 29 press release.

Andrew Casey, president and CEO of BIOTECanada, told The Hill Times that Bill C-64 is “a bit concerning,” and argued that the proposed pharmacare model feels piecemeal and ad-hoc, and could destroy the “balance in the system right now.”

“The bill sort of selects two areas [diabetes and contraceptives] in a system that’s got a balance there, and if you start to pull planks away, I don’t know what the impact is going to be,” he said. “I think it would make more strategic sense to address the gaps than pull planks out of the existing system and think that it’s going to stand up.”

Pharmacare will factor into broader lobbying efforts by BIOTECanada, which mainly focus on drawing innovation to Canada, according to Casey.

“Global companies are significant partners and investors in the ecosystem here, and if they’re not here because the environment is uncertain, we can lose their investment and partnership, which is worrisome for the Canadian biotech companies,” said Casey. “It’s this sort of Mobius cycle, that everything has to be in concert, and when you remove one piece of it, the whole thing kind of falls apart a bit.”

Read the article here: https://www.hilltimes.com/story/2024/04/01/first-phase-of-pharmacare-must-not-create-new-gaps-in-existing-coverage-say-lobbyists/416673/