Although National Pharmacare has been pushed for decades in Canada. It is still a policy that has yet to be implemented. One of the few missing pieces to Canada’s universal health care system is the lack of a nationally-funded universal pharmacare system. What defines national pharmacare varies from who you ask and what country’s public drug plan you’re looking at. For me, it is the following three things. (1) The federal government subsidizes prescription drugs to a greater extent by giving more targeted funds to the provinces to artificially bring costs down, (2) give greater negotiating powers to the Patented Medicines Prices Review Board (PMPRB for short) against pharmaceutical companies who wish to appeal to new patents to increase the prices of their drugs over time, and (3) establish a list of prescription drugs that all Canadians are covered by through general tax revenue (similar to how our healthcare system is funded). From these 3 points, I would say the first and the third are the biggest priorities in order to establish pharmacare. The second is a nice bonus as it allows the PMPRB to force pharmaceutical companies to lower their drug prices further so that it saves money for both federal/provincial governments (less tax revenue used) and saves out of pocket expenses for the consumer.
For pharmaceutical companies, giving greater negotiating powers to the PMPRB eats into potential profits as those drug prices will be forced to go down in the Canadian market to give greater access to people. And so far, it seems as though the Federal Liberals have dropped their plans for more affordable drugs. According to Justin Lings from Macleans, there have been internal negotiations happening between the Liberal government and the pharmaceutical industry which seem to indicate the Liberals have caved into the demands of the pharmaceutical industry. The big scoop? Essentially a threat from the pharmaceutical industry: if the government introduces harsher crackdowns on drug prices, investors will be pulling out of Canada’s already dying pharmaceutical industry. How much investment? 1 billion CAD according to Lings. With new vaccine production plants opening, new pharmaceutical investments flowing into Canada, and vaccine procurement being a must for the Canadian government; it’s no wonder the Liberals are taking the bait that the pharmaceutical industry has fished in. There’s too much risk; do the Liberals potentially risk the shutdown and/or stoppage of developing vaccine production plants in Canada, do they risk a lack of investment which will impact jobs, do they risk vaccine delivery? The answer is No to all of these questions.
The verdict is clear. Pharmacare and/or PMPRB reforms are not happening any time soon.
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It's no wonder that the latest reform on the PMPRB has been delayed not once - but multiple times. The regulations were delayed to be enforced four times, and now likely a fourth time. With a new Health Minister (Jean Yves Duclos) not having much experience in this role and the pandemic still going on, another delay of the new regulations will likely happen again. Furthermore, pharmaceutical industry leaders and CEOs have already called on the government to delay the new amendments to the PMPRB.
For the pharmaceutical industry, they argue that the new regulations would hinder new life-saving drugs being developed or sold in Canada. Pamela Fralick, the head of Innovative Medicines Canada - an “industry group” for pharmaceutical companies - states “innovative new medicines will not launch in Canada, depriving patients of potentially life-changing new treatments” if the regulations were to be enforced (Lings, Macleans). Health Canada has laid its position counter to Fralick, Health Canada says “there’s no evidence of a link between lower drug prices and reduced access to medicines” (Almazora, WP).
Outside of threats to withhold funds to Canada’s pharmaceutical industry and straight-up stating that new medicines will not launch in Canada. What else does the industry have to say about pharmacare? Court challenges. Yes, court challenges to undermine the powers of the PMPRB.
There have been court cases launched against the PMPRB’s constitutionality to undermine its negotiation powers against the pharmaceutical industry. This court case in Quebec had Innovative Medicines Canada (representing 7 pharmaceutical companies) challenge the legitimacy of the PMPRB’s authority to negotiate patented drugs. But more specifically, they challenged the new regulations that the Liberal government sought to pass stating that the PMPRB has no authority to broaden its powers. The Quebec Superior court upheld the PMPRB’s legitimacy and the federal government's ability for introducing new regulations.
The second verdict is also clear. There is a pharmaceutical lobbying interest to keep patented drug prices high in Canada.
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So what’s the future going to look like? Is Pharmacare dead? Not exactly. A commitment to pharmacare is a commitment to pharmacare. The Liberals have always delayed on policy (i.e. National Child Care), but in the end - they usually deliver. The biggest interest for the Liberals isn’t lobbying campaigns or investment, but whether they can stay in power for as long as possible. If pharmacare becomes a top 3 issue for Canadian voters, then you can bet the Liberals will bring in the pharmacare gun to the table and mow down the industry in a heartbeat. Even now, you can argue the reason the Liberals are so hesitant on pharmacare and stricter regulations is what effect it would have on the Canadian economy. They’re playing their cards safely, but the government (and certainly not Trudeau) isn’t shy to put their foot down on a policy and spend (i.e. covid supports, child care, business supports).
If pharmacare is politically advantageous, then you can bet that the Liberals will bring it on. One possibility is always on my mind, just as child care was a big-ticket in the previous 2021 election. Who’s to say pharmacare will be the big-ticket item in the next election. Making pharmacare buy-in agreements with each of the provinces before triggering a snap election and using the agreements as leverage to lure in progressive voters against the conservatives who would scrap the new pharmacare plan (just as was done in the 2021 election for child care).
All in all, will pharmacare happen in Canada? Probably eventually, I say. As a matter of when pharmacare will happen, I would say when the policy is politically advantageous to consider as an election platform for the Liberals.
In my opinion, the pharmaceutical industry shouldn’t focus too much on court cases and lobbying campaigns against the Liberals. They should focus their attention on voters. They have to convince the voter bloc in Canada that regulations against private pharmaceutical companies in our healthcare system are a bad thing. I know, a difficult task indeed. And probably one that isn’t possible as healthcare is consistently a top 3 issue for Canadian voters. Even the words ‘privatization’ and ‘healthcare’ in one sentence makes Canadians cringe - including myself. But I will say that the best systematic way to undermine the legitimacy of the PMPRB and the future of drug prices is through Canadians themselves (or if a court challenge ends up favouring the industry’s interests). How to do it? I don’t know, look at the US as an example.