Abstract
BackgroundCanadians have long been proud of their universal health insurance system, which publicly funds the cost of physician visits and hospitalizations at the point of care. Prescription drugs however, have been subject to a patchwork of public and private coverage which is frequently inefficient and creates access barriers to necessary medicine for many Canadians.MethodsA narrative review was undertaken to understand the important economic, policy and political considerations regarding implementation of universal prescription drug access in Canada (pan-Canadian pharmacare). PubMed, SCOPUS and google scholar were searched for relevant citations. Citation trails were followed for additional information sources. Published books, public reports, press releases, policy papers, government webpages and other forms of gray literature were collected from iterative internet searches to provide a complete view of the current state on this topic.Main findingsRegarding health economics, all five of the reviewed pharmacare simulation models have shown reductions in annual prescription drug expenditure. However, differing policy and cost assumptions have resulted in a wide range of cost-saving estimates between models. In terms of policy, a single-payer, ‘first-dollar’ coverage model, using a minimum national formulary, is the model most frequently advocated by the academic community, healthcare professions and many public and patient groups. In contrast, a multi-payer, catastrophic ‘last-dollar’ coverage model, more similar to the current “patchwork” state of public and private coverage, is preferred by industry drug manufacturers and private health insurance companies. Primary concerns from the detractors of universal, single-payer, ‘first-dollar’ coverage are the financing required for its implementation and the access barriers that may be created for certain patient populations that are not majorly present in the current public-private payer mix.ConclusionCanada patiently awaits to see how the issue of prescription drug coverage will be resolved through the work of the Advisory Council on the Implementation of National Pharmacare. The overarching and ongoing discourse on policy and program implementation may be construed as a political debate informed by divergent public and private interests.
Highlights
Canadians have long been proud of their universal health insurance system, which publicly funds the cost of physician visits and hospitalizations at the point of care
Canada patiently awaits to see how the issue of prescription drug coverage will be resolved through the work of the Advisory Council on the Implementation of National Pharmacare
Since the outset of Canadian Medicare, national commissions have repeatedly recommended that universal public drug coverage – universal “Pharmacare” as that vision is often called in Canada – be part of Canada’s universal public health insurance system [6,7,8,9]
Summary
This narrative review was informed by a structured search strategy applied to PubMed, SCOPUS and google scholar using combinations of the terms: ‘pharmacare,’ ‘Canada,’ ‘Canadian,’ ‘prescription drug,’ ‘drug coverage,’ ‘policy,’ ‘formulary,’ ‘provincial,’ ‘national’. If universal pharmacare in Canada is to be a catastrophic, ‘last-dollar’ model of public drug coverage, there will remain a major role for private insurers to provide plans for those interested and able to cover expenses below their annual deductibles and for medicines not on the national formulary. This is a form of complementary private insurance wherein the core, universal benefit of protection against catastrophic drug costs would remain a public responsibility. They contend that, should the federal government implement single-payer, ‘first-dollar’, universal coverage, an estimated $14–20 billion would need to be immediately earmarked for public drug expenditure that was previously reimbursed privately [88, 91]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
