National Pharmacare: Federal strategy to be announced in 2019
The pace of National Pharmacare discussion is picking up as Canadians anticipate the release of the Advisory Council on the Implementation of National Pharmacare’s (“Advisory Council”) federal public drug coverage strategy. Two previously released federal reports1 have examined fi nancial implications and possible strategies for National Pharmacare respectively and both support the implementation of a national model in some form.
The Advisory Council is tasked with assessing various models on their economic and social merits, working with governments and other stakeholders, and consulting with individual Canadians and experts in relevant fi elds. Their goal is to build consensus and find solutions for questions such as:
- Who will be covered and under what circumstances?
- What drugs will be covered?
- Who pays?
The current system faces many challenges. The Conference Board of Canada estimates that about 95% of Canadians already have access to either public or private drug coverage. For various reasons, many are still unable to obtain or adhere to the medications they need. Some Canadians may be either unaware that they might be eligible for existing programs, while others do not qualify because of income thresholds or diagnosis requirements. Under both public and private plans, out-of-pocket expenses like deductibles and/or co-payments may create a fi nancial barrier to drug purchase and/or adherence. While access to coverage is wide-ranging, it may be uneven, unattainable, or fi nancially out of reach depending on employment status, ability to navigate options, geography, or individual fi nancial circumstance. It is anticipated that national pharmacare would address current gaps in coverage for all Canadians, especially those who are currently uninsured or underinsured.
How it might look
Several models are being actively discussed. Each has merit, and each would address the overarching goals of access, equity, and overall benefit to Canadians to varying degrees. While it is uncertain which direction the Advisory Council strategy might take, here are some of the high-level possibilities:
||Possible model *Program logistics such as administration and funding would vary and are not considered in this document. ** Models listed below represent selected possible options only. There may be other models under consideration.
|Access, equity, and benefit
||Comprehensive public coverage (all Canadians covered for all medications)
Partial public coverage (essential medicines only – all Canadians covered for a curated list of essential drugs only)
Individual mandate (Quebec model) (all Canadians mandated to have equitable coverage, either public or private)
Optional public coverage (government sponsored drug plan available on an opt-in basis)
Targeted public coverage (like the current operational model where coverage is provided to vulnerable groups, but with a federal framework to standardize programs across the country)
Getting to the point for plan sponsors
Employers sponsor drug insurance programs to support a healthier and more productive workforce – a principle that is in line what might be achieved on a national level through national pharmacare. A 2015 Aon survey showed that not only do plan sponsors care about the outcome of ongoing discussions, their experience in managing drug plans gives them deep knowledge of and strong opinions on the administrative and funding models under consideration. A more recent Aon survey saw Canadian organizations list discussions around national pharmacare as a top 10 benefit plan priority for the coming year.
Though the federal strategy is still a work in progress, public comments from the Advisory Council chair hint at a continued place for private drug plan sponsorship. Aon will keep you informed as the federal strategy unfolds.
As always, Aon is committed to ensuring your workforce goals and benefi ts programs adapt and thrive in changing times.
1 Federal cost of a national pharmacare program (Parliamentary Budget Offi cer, September 2017) and Pharmacare now: prescription medicine coverage for all Canadians (House of Commons Standing Committee on Health, April 2018)