Barbara Martinez made the blunt comment during a panel discussion Saturday at an Ottawa conference on universal pharmacare sponsored by Carleton University and the Canadian Health Coalition.
Martinez told conference delegates that 59 per cent of Canadians have private drug plan insurance, most through their employers, and private insurers reimburse 53 per cent of all prescription drug spending. Among those covered by private plans, 83 per cent make claims, averaging $61 per prescription.
While the cost of “maintenance drugs” to control such things as blood pressure and cholesterol levels has risen by 58 per cent since 2005, Martinez said the biggest threat is the skyrocketing cost of new biologic and specialty drugs.
The average annual cost of those drugs per person is $15,000 a year, compared to $525 a year for maintenance drugs, she said, and a single prescription costs more than $2,200 on average. Costs for those drugs have increased by 325 per cent since 2005.
Given such increases, Martinez said, “the evidence clearly shows that most drug plans, as they exist, are not sustainable in the long term.”
Though drug plans are widely seen as insurance, they really aren’t because their costs are predictable, Martinez said. “The truth is, your employer is really just paying your benefits,” she said. If costs escalate, the burden falls on employers, not insurance companies, which simply increase premiums to cover the higher costs.
Traditionally, employers have responded by raising premiums or copayments for employees. “But that’s not sustainable, either,” Martinez said in an interview. New management techniques are essential, she said.
For example, Great West Life has begun to use case management in cases involving high-cost drug claims, Martinez said. “If you are taking a very high-cost drug, we are going to appoint a case manager to your case who’s going to monitor your use of the drug and your physician’s prescribing of the drug.”
Because the cost of prescriptions vary widely between pharmacies, when someone is approved for a high cost biologic drug, Great West Life “will be telling you which pharmacy you can get that prescription from, because we can save a substantial amount of money,” Martinez said.
“I don’t think employers want to stop paying for drugs or take access away,” she said. We just need to find better ways to manage these costs. There’s lots of low-hanging-fruit ways to save money without restricting access or taking coverage away from people who need it.”
Other conference participants said the best solution would be the creation of a government-run program of universal pharmacare that would cover all Canadians.
“Every developed country in the world with a universal health care system provides universal coverage for drugs, except Canada,” said Steve Morgan, associate director of the Centre for Health Services and Policy Research at the University of British Columbia.
Those countries all spend far less on prescription drugs than Canadians spend, and their citizens have better access to essential drugs than Canadians do, Morgan said.
In total, spending from all sources on pharmaceuticals in Canada tops $30 billion a year and exceeds $900 per capita. By comparison, spending on prescription drugs in the United Kingdom — which has a universal drug plan — is dramatically less per capita, Morgan said.
“If Canada could achieve what the UK achieves through universal coverage, we would save $14 billion a year,” he said. “That’s enough to pay for universal pharmacare entirely at current public spending levels on prescription medicines. We would not need to increase taxes if we achieved the outcomes in the United Kingdom.”
According to a 2010 study by Carleton University professor Marc-André Gagnon, a co-organizer of the conference, Canadians pay 30 per cent more than the OECD average for prescription drugs. Defenders of the present system argue those higher prices help attract drug research and development to Canada.
But Morgan noted that Canada is “barely even on the charts” in terms of pharmaceutical research and development relative to comparable countries with universal pharmacare that spend far less per capita on prescription drugs.
“You don’t need to shower the industry with revenues on the payer side in order to attract scientific investment. You do so by investing in science, not by pouring money into the industry.”
One reason drug prices in Canada are so high, Morgan said, is that the lack of a single buyer “fundamentally fragments our buying power.” The experience of New Zealand, which does rigorous drug reviews and negotiates hard on price, is a “powerful lesson” for the rest of the world, he said.
““You can take a population as small as four million people and leverage that through negotiations to drive down prices when you are the buyer. When you have multiple buyers, you set up, in a sense, an auction. That drives prices up, not down.”
Though the current Conservative government has shown no interest in universal pharmacare, Gagnon said grassroots support for the idea is growing.
“More voices are being heard, (saying) there’s a huge problem, the system is not sustainable, premiums are increasing way too fast, so something needs to be done about this,” he said in an interview. “This is a question of political will. This is a question of regulatory capture by some vested interests.”
If the political will is lacking at the top, Gagnon said, “it’s going to be coming from the grassroots. This is a rational policy that makes sense, could save money and improve health outcomes.”
Original Article
Source: canada.com
Author: Don Butler
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