DRUG BUST Alan Cassels

Wanna talk pharmaceutical politics? Then ask yourself these two questions: If a new drug is marketed in Canada, does that mean the government should pay for it? And further, if your doctor prescribes a drug that is deemed essential, should you have to pay for it yourself?

If you’re like me, the answer to the first question is “Of course not.” There are lots of drugs on the market, many of which either do very little to improve the quality of your life or may even be harmful. We shouldn’t expect the public purse to pay for these frivolous drugs, especially when there are already so many other urgent demands for our precious health care bucks. The answer to the second question is the same: “Of course not.” In Canada, we don’t pay out of our pockets for essential health services like doctor or hospital visits so why would we expect to have to pay for an essential drug?

By the time you read this, we’ll be in the final sprint for the election finish line. Even though there have been enough mini-scandals, resignations and apologies to keep a hungry media at bay over the last month, and we have heard a lot about what governments would do about crime, infrastructure and childcare, we’ve heard barely a word about health care. Certainly, almost nothing about the biggest elephant in the room – Canada’s pharmaceuticals budget.

Yet this crazy election season is the most appropriate time to be asking, "How well do Canadian governments, both provincial and federal, provide drug coverage to our populations?” Sadly, we are a pathetic country on that front. A recently released report said that among developed countries, Canada is almost last in terms of its level of public coverage of pharmaceuticals.

It seems that for every dollar that goes towards pharmaceuticals in Canada, about 45 cents come from the government; about 35 cents come from your private insurance plan that you would have as part of your employment if you are lucky (even though you are ultimately paying for it because that money comes off your pay cheque one way or another); and the final 20 cents come out of your pocket. The report stated that we scored a dismal seventeenth out of 18 countries, in terms of public drug spending. In contrast, the UK spend on drugs is more than 80 percent from the public purse.

This is a real shame and obviously an election issue that should have huge prominence, given the fact that, in 2007, spending on drugs in Canada reached $27 billion, a figure that represents almost 17 percent of total health care spending. According to the Canadian Institutes of Health Information, after hospitals, drugs account for the largest share of major health expenditures.

It is criminal if Canadians are doing without life-saving drugs because they can’t afford them (though I’m not convinced this is much of an issue). Suffice to say this study provides some evidence that Canadian politicians lack the political will to enact strong, national legislation to pay for our drug costs.

This is certainly not the vision Tommy Douglas had when he established public health care in Canada. Even the Romanow Commission, which is one of the most extensive examinations of Canada’s health care system ever undertaken, recommended a national, catastrophic pharmacare program.

Have we seen anything in the last five years? Nada.

The second important statistic to emerge from this study, which also slams Canada as miserly and misdirected on drugs, is a dismal score of sixteenth out of 18 countries, in terms of access to new drug treatments. While that may strike most people as pathetic, I’m a lot more understanding about this one. When you consider the dismal batch of drugs coming onto the market that are deemed “new” and which arrive on the scene with massively inflated prices compared to existing treatments, you’re not really missing much.

Let me explain: the study looked at a comparison of 36 new drugs evaluated for public drug plan reimbursement by all developed countries. Canada’s Common Drug Review (CDR) the federal body which decides, based on an assessment of the drug’s safety, effectiveness and cost (and makes recommendations whether a new drug deserves public coverage), recommended only 61 percent of drugs for public drug plan reimbursement. Apparently, this is a lot less than the averages of the European Union (EU: 91 percent) and the US at 88 percent.

Most people are thankful that the government does its part to pay for pharmaceuticals. And yet, whether you get access to “new” drug treatments, Canada is apparently not a good place to live. The study was produced by a Toronto health consulting firm and paid for by Rx&D, the association of Canada’s brand name drug companies, with the claim that it is the first comprehensive study of its kind evaluating Canada’s access to new drug therapies.

LetÅñs talk about the access issue because the drug companies and their surrogate patient groups are always screaming blue murder about the lack of access to new drugs in Canada. We’ve got a situation in which about half the ?new” drugs recently approved for sale in Canada – drugs for HIV, cancer, heart disease – aren’t recommended for coverage. The Common Drug Review, a serious contender in establishing proof of evidence when it comes to making decisions about coverage, apparently issued 78 recommendations between 2003 to the end of 2007, giving a positive recommendation only 46 percent of the time.

Even though this study apparently demonstrates that Canada is not keeping pace with other countries, in terms of new drug coverage, it is the lack of public funding overall that I think is the most serious issue.

Where do the various political parties weigh-in on this issue?

We know, for example, that the NDP supports a National Pharmaceutical Program. On his website, Jack Layton says that he “…hears about the prescription problem in every single province he visits.” He knows the numbers too; he’s aware that between 1992 and 2002, household spending on prescription drugs jumped by more than 70 percent, while over the same period, spending on food, clothing and shelter increased by only 11 percent.

Layton decries the fact that almost 20 percent of Canadians do not have adequate drug coverage and God forbid, if they find themselves in a situation where they cannot afford the medication they need, they would be ?…forced to choose between medications or mortgage payments.

What Mr. Layton doesn’t say is that many of those drugs that Canadians are paying for may not actually be worth the money demanded at the pharmacy counter, when you know what kind of health outcome they will deliver. However, he’s not adverse to a bit of fear mongering when it comes to putting demands on the government. He says access to medication should be based on need. ?Canadians want to know that if they get sick and can’t afford the drugs they need to survive, the federal government will step in to help.” I have to give some credit to the NDP when they say that if they were paying for drugs, they’d at least look at “essential” medicines and ensure that those Canadians who carry a heavy burden of paying for drugs would get some help.

Where do the Liberals stand?

It’s hard to say, but, like a lot of issues, the Liberals are stealing the best parts from the NDP. Liberal Leader Stéphane Dion promised a ?national program to fund high-cost drug treatments for people who suffer from serious and chronic illnesses – a program aimed at extending coverage to provinces in Atlantic Canada that don’t have provincial drug plans.” Dion said the Libs would spend $900 million over four years and ?ensure people in all provinces can afford expensive drugs like kidney cancer treatments that can run as much as $7,000 per month.”

How about the Conservatives? Let’s start by saying that many drug lobbyists are deeply connected with the governing Conservatives. In an article in the National Post on May 6 of this year, it was revealed that two high profile Conservatives were mired in the muck around the drug companies’ efforts to restrict the availability of generic drugs. Then there was the stinky business about a former communications director for Stephen Harper, who became a lobbyist for the company that owned the vaccine for cervical cancer for which the Conservatives allocated $300 million.

There’s no doubt that the brand name drug industry is one of the most powerful in Canada, and if anyone is keeping drugs out of the hands of Canadians (due to their high prices), it is those folks.

Let me add one final bit. There is a Conservative I’d vote for if he was running in my riding. Terence Young, who is running for the Conservatives in Oakville, is one of Canada’s staunchest supporters of weapons-grade drug safety legislation. He’s spoken publicly in favour of strong legislation supporting the recommendations of the Romanow Commission, especially the one about establishing a new Drug Agency for Canada to ensure Canadians are safer when using prescription drugs.

Alan Cassels is a drug policy researcher at the University of Victoria. He was recently interviewed on CBC Radio’s White Coat, Black Art on the subject of public funding of pharmaceuticals in Canada. You can catch this program at www.cbc.ca/whitecoat.
cassels@uivic.ca