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Editorial: National pharmacare is not the highest priority

Under the new pharmacare plan, must any drug deemed necessary by a physician be covered?

The federal New Democrats have tabled legislation in Parliament to introduce a national pharmacare program.

In one respect, that seems understandable. In the confidence-and-supply agreement worked out with the Liberals to keep them in office, the NDP were promised such a program.

That promise has not been honoured.

But here, the problems begin.

The legislation copies, almost to the word, the Canada Health Act, which laid the foundations for our national health-care service. Hence the pharmacare program is to be publicly funded, publicly administered, and comprehensive.

The comprehensiveness requirement is important. Under Medicare, any clinical treatment deemed necessary by a physician must be covered.

Under the new pharmacare plan, must any drug deemed necessary by a physician be covered?

Leave aside whether this is constitutionally doable: The Constitution Act gives delivery of health services exclusively to the provinces.

None of the provinces offer the unqualified, comprehensive coverage stipulated in the act.

All of the country’s provincial drug plans reserve the right to say which drugs will be covered, and which will not. The reason is simple.

There are numerous drug categories where several medications offer similar or identical benefits, but often at widely differing costs.

B.C. has pioneered two programs to save money, the Reference Drug Program and the Biosimilars Program. Together these lay out which drugs with equivalent benefits are cheapest, and physicians are asked to prescribe them (though exceptions can be made in special circumstances).

It has been estimated that if these two programs were adopted nationwide, the savings would approach $1.5 billion.

But no provision is made for either of these cost-saving strategies in the Act.

What about expensive drugs for rare diseases (EDRDs)? Some of these medications can cost $2 million per patient every year for life.

Are those to be covered? No word on that either.

Next, what happens to drug coverage provided by private insurers?

Millions of Canadians have private drug insurance through their employers. Is it now proposed that taxpayers will take on this responsibility?

It certainly appears so, for no provision is made in the legislation to keep private insurance in place.

This is no small matter. Nationally, 37 per cent of all prescription drug costs, totalling around $13 billion, are paid by private insurers. That’s $13 billion the public purse must now find if the act is passed.

But that is characteristic of this legislation. It either ignores, or passes quickly by any of the numerous management techniques that provincial drug plans have evolved to keep costs affordable.

Then again, how is the program to be paid for? If cost-shared funding is proposed for such a new and massively expensive project, as must surely be required, would the provinces trust Ottawa to keep its word as the years pass by? That promise wasn’t honoured with Medicare.

There is a wider issue here. Our 60-year-old health service is in danger of becoming a failed experiment.

We have not enough physicians, not enough nurses, not enough ER or ICU capacity, not enough operating room capacity, not enough medical school training spaces.

Just last week we learned that donated kidneys are going to waste in B.C., or being transported out of province, due to a shortage of transplant surgeons.

With private, two-tier medicine a growing presence, the last thing we need is a new and open-ended commitment that will divert yet more resources from Medicare.

What we desperately need from our political leaders in Ottawa is willingness to focus on the task at hand, and the well thought-out use of powers already granted them.

Yes, a national pharmacare program would be wonderful, but necessities come first.

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