National Pharmacare consultation: CLHIA says “smart reforms” would build on present system

By Susan Yellin | October 04 2018 09:30AM

Stephen Frank

The Canadian Life and Health Insurance Association (CLHIA) has set out a list of recommendations that it says will protect health benefits, ensure access to affordable prescriptions and ensure affordability for taxpayers and consumers.

The CLHIA says the recommendations, included in a submission to the federal advisory council looking into a national pharmacare plan, can be achieved on a timely basis by moving forward with “smart reforms that build on the strengths of the current system.”

A path forward

“The most important thing is that there is a path forward that builds from what’s working well today and that will also achieve the policy goals the council has identified which is to ensure there are no gaps in access and to improve the financial situation within the pharmacare system,” Stephen Frank, president and CEO of the CLHIA said in an interview. “If they do it in a smart way, this can be done quickly and Canada will be very well served.”

In the submission, the CLHIA says any reform should ensure that private health benefits plans stay in place. “Putting them in jeopardy will mean delayed access to new, innovative medicines and could put more than 7.7 million Canadians at risk of seeing a change in access to medications they are already using – with those suffering from depression, cancer, diabetes and chronic pain being the most impacted,” states the paper.

Keeping the current system of public and private plans is a model that would also reduce overall costs and improve access, while making effective use of taxpayer dollars, says the CLHIA submission.

National minimum standard formulary

The CLHIA also suggests that a national minimum standard formulary be established to cover chronic and rare diseases. The formulary would set a maximum for out-of-pocket costs, potentially based on income. The government should also work with industry to set a risk-sharing model for high-cost drugs to ensure all regions and employers can offer the minimum standard formulary.

The CLHIA supports reforms to the Patented Medicine Prices Review Board (PMPRB), which regulates the maximum price that can be charged for a drug in Canada. Currently, the board sets the cap by comparing prices in Canada to a basket of seven other countries. Canada has always tried to be the median of the seven countries, says Frank.

The problem, however, is that the other countries have been the highest cost countries in the world. Ottawa is bringing in new reforms to try to get Canadian prices much lower.

Frank said the CLHIA has polled Canadians and well over 90 per cent support the view that Canada should enact reform for those who need it, but not to put at risk the benefits they already receive.

“Public sentiment is to fix the system so that those who are being left behind are helped; address some of the cost pressures but not in a way that jeopardizes what’s already working.”

The advisory council is expected to release a report in June 2019 and from there the federal government will decide on next steps.

To learn more, consult the CLHIA`s submission here.