Statement made on 27 April 2010 by Senator Catherine Callbeck
Hon. Catherine S. Callbeck:
Honourable senators, once again, I rise to bring your attention to the lack of a universal catastrophic drug coverage program in this country. I remind honourable senators that a catastrophic drug coverage program ensures that individuals do not suffer undue financial hardship from prescribed medications. Given the importance of this issue and for the benefit of newly appointed senators, a bit of background is in order.
Why is a catastrophic drug plan important for Canadians? The Canada Health Act, which sets out the expenditure framework for our health care system, covers prescription drugs used while a patient is in hospital. Yet, Canadians are receiving more new drug therapies than ever before thanks, in part, to advances in technology. As a result, spending on prescription drugs is taking up an increasingly large share of what Canadians spend on health care.
Ten years ago more than 100,000 Canadians experienced annual drug expenses over $5,000. That number is much higher today: Nearly one in 10 households is spending 3 per cent of net income on prescriptions. A recent study by the Institute for Research in Public Policy noted that per capita expenditures on prescription drugs increased by 338 per cent from 1975 to 2006, which is well in excess of economic growth in this country.
Many Canadians receive some help with their drug costs through a patchwork of public and private insurance plans. The Health Council of Canada estimates that there are 19 publicly funded drug plans in Canada — 10 provincial, three territorial and six federal — as well as more than 1,000 private drug insurance programs, which are usually part of employee benefit packages.
There are serious problems with this current level of coverage. First, some Canadians are falling through the cracks. An estimated 2 per cent of our population — more than 640,000 people — have no coverage at all. In fact, more than one quarter of Atlantic Canadians have no drug coverage. Studies show that people who work at part-time or low-wage jobs are most likely to be under-insured or without a drug plan. They simply try to get by on their modest incomes and are least likely to have extra money for prescriptions.
I am certain that all honourable senators have firsthand knowledge of family members, friends or neighbours who must ration their prescription drugs or do without necessary medications entirely because they cannot afford to pay for them. We have all heard stories of Canadians having to decide whether to buy food or buy their medication.
The absence of a universal catastrophic drug plan in Canada has long been recognized as a serious problem. The Standing Senate Committee on Social Affairs, Science and Technology, of which I was a member, issued a report in 2002 that called for the expansion of drug coverage to include protection against catastrophic prescription drug costs. The committee's report stated:
No Canadian should suffer undue financial hardship having to pay for necessary medical treatment. It is essential that this principle be applied to prescription drugs expenses.
The first concrete steps were taken at the 2003 First Ministers Accord on Health Care Renewal. This agreement committed governments to a number of goals including that Canadians, wherever they live, have reasonable access to catastrophic drug coverage by the end of 2005-2006.
The second major step forward came in 2004 with the First Ministers Meeting on the Future of Health Care and a 10-year plan to strengthen health care. Once again, first ministers agreed:
No Canadian should suffer undue financial hardship in accessing needed drug therapies and that affordable access to drugs is fundamental to equitable health outcomes for all our citizens.
The first ministers established a task force to develop and implement the National Pharmaceuticals Strategy, which, among other tasks, would design and calculate the cost of the options for catastrophic pharmaceutical coverage.
The first progress report of the National Pharmaceuticals Strategy was issued in September 2006. It listed four significant accomplishments. First, federal-provincial-territorial representatives agreed on principles to guide the development of a catastrophic drug coverage plan. These principles called for a plan that is universal, equitable, transparent, evidence-based, integrated and sustainable. Second, the task force developed and calculated the costs for two plan designs based on either a fixed or variable percentage of family income. Third, they agreed to expand the federal Common Drug Review as the basis for a national formulary. Fourth, the task force agreed to establish a national framework for a program that would cover expensive drugs for very rare diseases.
September 2006 was the last time that the federal government was involved actively in any work on a catastrophic drug plan. The provincial and territorial health ministers continued without federal representation at their meeting in September 2008. They reached an agreement on the basic outline of a catastrophic drug coverage plan. This plan would ensure that prescription drug costs would not exceed 5 per cent of family income and that the costs of drugs above that level would be equally shared between the provinces, territories and the federal government. However, with the federal government unwilling to engage, the provincial-territorial proposal could not be completed. To my knowledge, there has been no further public information on the status of a catastrophic drug coverage plan.
I would like to quote from the January 2009 Health Council of Canada report entitled The National Pharmaceuticals Strategy: A Prescription Unfilled. It states:
The first few years of the National Pharmaceuticals Strategy involved "unprecedented" collaboration between federal and provincial/territorial governments. But then governments changed, and progress slowed.
The early cooperation and collective action of a national effort had been lost.
In recent months, when I have raised this issue of a lack of progress on a catastrophic drug plan, I have been told that the Government of Canada already transfers billions of dollars to the provinces through the Canada Health Transfer. That is all well and good, but the remark does not provide any information about what the federal government proposes to do about a national catastrophic drug plan.
I have been told, and again I quote:
. . . the federal government respects the provinces' unique role in the delivery of health services.
While provincial and territorial responsibilities in health care are well recognized, this does not prevent federal participation with the provinces and territories in developing and funding a catastrophic drug coverage plan. There is no reason why the Government of Canada cannot continue its historic role of providing leadership and collaborate with provinces to design and implement a catastrophic drug plan like it was doing until September 2006.
Finally, I have been told that progress can be made toward a catastrophic drug plan through federal-provincial collaboration and that "this government continues to welcome opportunities to work with provinces and territories on pharmaceutical issues."
If this is true, why have we not heard from the federal government about the agreement for a basic catastrophic drug plan that was reached by the provinces and territories in September 2008?
Canadians need to know what specific steps the Government of Canada is taking to ensure this collaboration in developing a plan and calling for meaningful action on a catastrophic drug coverage plan.
In calling for meaningful action on a catastrophic drug coverage plan, I do not intend to minimize the challenges we face. Governments across this country are struggling to manage deficits. There are many worthwhile competitors for our tax dollar — education, child development and income security programs.
Honourable senators, a long-recognized Canadian value is that we provide a minimum level of health care coverage for our citizens. The time has come to ensure the protection of catastrophic drug costs as part of that coverage.
In 2008, provincial and territorial governments agreed on a broad outline of a drug coverage plan, and now the Government of Canada must resume its leadership role. I urge the federal government to step up and continue work on the catastrophic drug plan so that no Canadian suffers financial hardship because they need expensive medications.