How the NDP pharmacare plan could impact the quality and accessibility of drug insurance for Canadians

Emmanuelle FaubertIf the New Democrats have their way, your drug insurance coverage could take a turn for the worse.

As part of their agreement to keep the Liberals in power, the New Democrats have stipulated certain conditions. One of these is the adoption of a single-payer universal drug insurance plan from coast to coast.

While the idea of expanding access to insurance to one and all may have some merit, the formula the NDP and the Liberals have adopted risks imperilling coverage quality for millions of Canadians.

Their plan, in its first phase, covers birth control and diabetes medication under a federally imposed plan across the country. Yet, they have been clear that these two categories are just the first phase towards establishing a comprehensive, universal single-payer pharmacare system across the country.

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Universality is not the problem; it is the single-payer aspect of the pharmacare plan. What the members of the New Democratic Party are asking for amounts to the abolition of private drug insurance, to be replaced by a single plan administered by the government.

Whatever province you reside in, private drug insurance plans cover many more different medications than public plans. On average, coverage is 51 percent more extensive in a province’s private plans.

In Quebec, the province with the most generous public coverage, this difference is 59.6 percent.

Indeed, extending coverage akin to Quebec’s public drug insurance to the entire country would risk compromising the quality of coverage for 21.5 million Canadians by the imposition of a government monopoly in this area.

And loss of coverage could mean loss of access to drugs.

Already, some pharmacists are raising a flag about what reduced insurance coverage could signify. Alan Low of Medicines Access Coalition, for instance, says that coverage by some form of insurance is often a key factor in determining whether or not to distribute a drug in a given jurisdiction.

When you consider that less than half of drugs that have entered the Canadian market over the past decade are covered by public plans, it’s enough to send a shiver up your spine!

Additionally, there is the problem of delays in approval. The regulatory pathway a new drug must navigate before being marketed is already long and costly.

Once a drug is approved by Health Canada, it takes an average of 226 days before a private insurer approves its coverage. That’s a little over seven months.

That might seem long, but it’s nothing compared to the approval delays of public plans. On average, it takes 732 days after approval by Health Canada, or a little over three times as long, before a public plan adds a drug to its list of covered treatments.

In other words, if an innovative drug is needed to treat your ailment, you’d best be patient if your only option is public insurance.

Should federal politicians want to guarantee drug insurance coverage for all Canadians, more focused, targeted options would achieve this goal without jeopardizing the coverage quality of the majority.

Currently, thanks to public and private drug insurance plans, just under 90 percent of the Canadian population has drug insurance coverage.

That still leaves 4.9 million of our fellow citizens who, for a variety of reasons, have no insurance coverage. Among these, the most vulnerable are surely the 1.1 million Canadians who are not eligible for insurance coverage, be it public or private.

A targeted program aimed at this latter category of citizens would have the benefit of improving their access to health care without jeopardizing the access of tens of millions of Canadians for whom the current system works much better.

Given the current strain on federal public finances, this approach would also have the advantage of not significantly increasing the deficit, unlike a single-payer universal program.

Furthermore, implementing an insurance mandate similar to Quebec’s model would ensure universal coverage while still allowing individuals to choose between private or public insurance.

The NDP’s request, in its current form, poses a significant risk for the insured. Hopefully, other federal politicians will adopt a more prudent approach.

Emmanuelle B. Faubert is an economist at the Montreal Economic Institute.

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