Prime Minister Justin Trudeau has assured Canadians they will continue to have access to the medications they need, and that there is a “steady and solid supply." His remarks came in response to a decision by the Trump administration to permit U.S. wholesalers to purchase drugs in Canada, where prices are sometimes lower.
We’ll return to the threat from America in a moment. But first, how can the PM give such an assurance when there is already a major shortage of drugs in Canada? This is literally whistling past the graveyard.
Health Canada’s website lists medications that are either in short supply or outright unavailable. There are 38 drugs on the list, and it is not up to date. Verapamil, for example, a widely prescribed medication for high blood pressure and arrhythmia, is not on the list. Yet pharmacists in Greater Victoria say they cannot find a supplier, and have no idea when that will change.
Now there are several reasons why a medication might come off the market for a time, and not all can be blamed on government inaction.
Sometimes pharmaceutical companies have to pause production because of technical issues. Occasionally drugs are recalled because a dangerous side effect becomes known.
But there are other problems that very definitely could be remedied. First, large numbers of American visitors are crossing our border each year to buy drugs that are cheaper than at home. Insulin is one example.
Now this is only possible if a Canadian physician co-signs a prescription written by an American doctor. Otherwise pharmacies here cannot fill the order.
But this is not appropriate medical conduct. Those Canadian doctors who co-sign prescriptions know nothing about the patient involved.
Colleges of physicians and surgeons decry the practice, and some physicians have been disciplined. Yet the practice continues. This must stop.
Second, in recent years some pharmaceutical companies have been replacing existing, low-cost drugs with medications that are no more effective, then raising the price, sometimes astronomically.
For example, until 2017, patients with a rare genetic disorder that affects eyesight could be treated with a drug that cost around $5,000 a year. The medication was not licensed in Canada, meaning patients had to get a special authority from Health Canada to import it.
But recently a pharmaceutical firm gained the right to distribute a similar drug in Canada, and promptly raised the price of a year’s supply to $300,000.
How is this possible? Because Health Canada gave the company a licence. That meant the cheaper version was effectively shut out, because a licensed product was now available.
What were our federal bureaucrats thinking? Children might lose their eyesight because of this shocking display of indifference. B.C.’s health minister, Adrian Dix, has raised the matter with his federal counterpart.
Perhaps it will be argued that Health Canada was merely following a long-standing policy. Then change the policy.
Returning to the Trump administration, the U.S. Food and Drug Administration has been tasked with helping American wholesalers purchase large volumes of medications sold in Canada.
Drugs are sometimes cheaper here, because unlike the U.S., Canada has a medicine prices review board that works to keep costs under control. However, we certainly do not have the quantities required to meet U.S. demand, and at the same time maintain domestic supplies.
Some in the legal community believe the FDA’s new policy is forbidden under American law, and will not withstand a challenge. But that could take years.
There are several solutions our federal government could examine. One might be to declare this a matter of national security, and halt the export of targeted drugs to the U.S. if doing so would endanger domestic supplies.
Another option could be to prohibit Canadian manufacturers from re-selling their product to U.S. wholesalers. This would almost certainly provoke a legal dispute, but one the government has a good chance of winning.
Regardless, the federal government has no more critical duty than ensuring an adequate supply of life-saving medications. As things stand, Health Canada appears more interested in a quiet life, than getting on with the job.