Gite and Kaplan-Myrth: Lack of pharmacare a hard pill to swallow

One in five Canadians does not have drug insurance or does not have enough insurance to cover the cost of drugs.

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Bill walks into his family doctor’s office and quietly pulls out his diary of home blood pressure readings. He is a working Canadian who pays his taxes and relies on Canada’s universal health care system. He suffers from diabetes, high blood pressure and high cholesterol and takes medication for each. He is shy to tell his doctor that he just lost his job and the drug plan that came with it, so he can no longer afford his medication. To make his medication last longer, he had started cutting his pills in half, lengthening the time between doses, and sometimes not filling a prescription due to the high cost. He asks his doctor: “Which of these drugs can I do without?”

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Bill is not a real patient, but we doctors have all met someone like him. His situation represents thousands of patients across the country. One in five Canadians does not have drug insurance or does not have enough insurance to cover the cost of drugs. A 2020 poll showed that 23% of Canadians decided not to fill or renew a prescription, or took steps to extend their supply, because they could not afford the prescribed dose.

We must close this glaring gap in public health care by expanding it to include pharmacare. I hope it is about to happen.

Last week, Prime Minister Justin Trudeau and NDP Leader Jagmeet Singh announced a Liberal-NDP deal that includes a promise to deliver national pharmacare and dental care. The government is committed to passing a Canadian Pharmacare Act by the end of 2023 and will task the National Medicines Agency with developing a national essential medicines formulary by 2025.

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A national pharmacare program is not only fair and ethical, but economical. Several studies have shown that investing in a national pharmacare program would actually save money, citing up to $9.2 billion saved in total spending. A national pharmacare plan will also provide more leverage and bargaining power to lower drug prices through bulk purchasing for the whole country, a critical shift given that Canadians currently pay some of the prices of the highest drugs in the world.

These estimates do not take into account cost savings from a healthier population. A population that can afford to take medication and stay out of hospital will have better health outcomes, saving the costs of emergency or complex medical care. Paying for drugs that treat high blood pressure, diabetes, and high cholesterol will be cheaper than treating heart attacks, strokes, or kidney failure.

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While the renewed promise of national pharmacare is worth celebrating, we remain cautiously optimistic until it is implemented. For years we have heard of a national pharmacare program, but we have gotten little more than promises of promises.

Physicians see firsthand the circumstances many Canadians face and how a national pharmacare program will improve their quality of life. It is heartbreaking to look into the eyes of patients who fall through the cracks of our health care system. They have no private supplementary health insurance provided by their employer or purchased from an individual. They don’t have deep enough pockets. They are not eligible for provincial disability insurance.

With universal pharmacare, our patients will no longer have to choose between putting food on the table and taking their medication. They won’t have to cut their pills or decide from paycheck to paycheck which health issue needs the most attention. Workers will not be “job locked in,” that is, tied to their workplace for fear of losing drug coverage for their families. A life-changing diagnosis requiring treatment with expensive drugs will not plunge families into medical poverty.

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Until pharmacare is in place, Canada will remain the only high-income country with a universal health care system that does not include universal pharmacare. It’s been a hard pill to swallow for too long. “Universal” health care is a hallmark of Canada’s identity, committing to providing medically necessary care based on need, not ability to pay. This same principle must be applied to prescription drugs.

Dr. Jasmine Gite (@jasminegite) is a family medicine resident in Hamilton. Dr Nili Kaplan-Myrth is a family physician in Ottawa (@nilikm). They are both board members of Canadian Doctors for Medicare (@CdnDrs4Medicare).

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