In a statement issued on November 15, 2023, the Canadian Institute of Actuaries (CIA) proposed a series of measures to improve both the provincial public drug coverage plans and those of private insurers. 

The CIA believes that these measures can achieve the goal of providing coverage to all Canadians more efficiently and quickly than a single government payer can. This statement from the actuarial group comes in the wake of statements from other industry organizations, following national pharmacare envisaged by the Canada Pharmacare Act. 

"One size does not fit all when it comes to the unique provincial and territorial situations of drug care in this country," says Steve Prince, President of the CIA. "The CIA issued a report on this topic in 2021. What that report says is still true today," he adds. In this report, the Institute stated that establishing a framework for prescription medications does not necessarily mean replacing existing structures entirely. 

Public-private partnership 

The group of actuaries proposes that each province or territory cover all its residents through a "platform" that combines funding and service delivery from the public and private sectors. "A federally established national formulary of drugs would ensure consistency of benefits across the country. The federal government would contribute to the stability of the program by covering costs beyond a certain threshold," explains the CIA. 

Negotiator and reinsurer 

According to the model proposed by the Canadian Institute of Actuaries, the federal government should negotiate drug prices on behalf of all public and private schemes, among other things. 

Its proposal: 

  • Builds on what works within the existing prescription drug landscape in Canada; 
  • Establishes a national formulary of prescription drugs that all Canadians can access fairly and equitably; 
  • Provides provinces with the flexibility to develop their own pharmacare programs; 
  • Establishes a funding mechanism that would see the federal government partner with the provinces as a reinsurer of provincial risk; 
  • Recognizes that the system must be allowed to evolve over time as experience matures and costs and potential savings in other areas become clearer; 
  • Ensures a management structure is in place to find savings in improved medical prescribing habits and loss prevention; 
  • Leverages the purchasing power of a national operation to negotiate directly with the pharmaceutical manufacturers to generate fundamental savings. 
Hybrid approach 

"Finding a way to help all Canadians get the medicine they need does not automatically mean a single-payer government administered program that fully replaces existing plans. There are good reasons for a hybrid approach," says Rob Brown, Co-Chair of the CIA’s pharmacare task force. 

Brown believes that private insurers' group plans currently provide significant and independent funding. Replacing them, he says, would require "new taxes or other mechanisms." "We should build on the existing foundation to help Canadians more effectively and cost efficiently," he adds. 

Erin Crump, member of the CIA’s pharmacare task force, believes that all Canadians should have fair and equitable access to medications through a system that reduces costs and eliminates barriers. "It will take the combined efforts of both public and private entities to make this a reality," she says.