HALIFAX – There’s no argument Canada needs a plan to help people faced with catastrophic drug costs – the challenge is convincing governments and taxpayers that the short-term expense will pay long-term dividends, participants in a forum on prescription drug coverage heard Tuesday.
The $15,000 annual price tag for an effective rheumatoid arthritis drug call Enbrel is only a fraction of the cost of treating an uncontrolled disease, patient advocate Linda Wilhelm of New Brunswick told the conference organized by the Atlantic Institute for Market Studies.
Her arthritis was so severe she relied on a wheelchair and had to be hospitalized for more than two months in 1999 before convincing the provincial government to pay for the drug.
She estimated the 10-year cost of treating her condition before she began Enbrel was $576,826. Two weeks after beginning the drug, which would cost $150,000 over 10 years, she walked out of the hospital.
“Where’s the cost savings to the government to deny these medications?” she asked.
A survey of the 45,000 members of the Canadian Diabetes Association found one in four could not afford the medications recommended by their doctors or access them through public or private insurance plans, said Karen Philp, national director of public policy and government relations for the group. Two per cent of Canadians have no drug coverage.
The cost of treating diabetes and its complications costs Canada more than $13 billion a year and is projected to increase. But the projected costs of setting up a national program to protect those Canadians whose-out-of pocket drug bills exceed three per cent of their income (one common definition of “catastrophic”) are less than $500 million, Ms. Philp said.
In order to set up a sustainable catastrophic drug program in Canada, we need to give up the notion that the government pays for health care and remember that citizens foot the bill through taxes, said health economist Bryan Ferguson of the University of Guelph in Ontario.
Public health care is in fact a sort of insurance plan, but the current “pay as you go” approach, based on the premise one draws on the health system about as much each year as one pays in, can’t stand up over the long term.
Mr. Ferguson suggested a catastrophic drug plan be set up on an insurance pool basis, accounting for the expected intergenerational gap in demand for drugs. Such a scheme would take drug coverage out of the hands of politicians, who tend not to think of the long-range implications of some health-care decisions.
The government’s role would be to subsidize the premiums of low-income citizens.
John Abbott, deputy minister of health for Newfoundland and Labrador, said a new program in his province that will extend benefits to an additional 100,000 people could serve as a bridge to a Canada-wide program.
A report on a national pharmaceutical strategy is due at the end of June, but Mr. Abbott said federal Health Minister Tony Clement wasn’t eager to discuss catastrophic drug coverage at a meeting with his provincial counterparts last week.
“We feel that our government has taken up the gauntlet,” he said. “What we need now is a federal political will to act, and we hope the federal government is listening.”