Thank you for that question.
It is important for committee members and other people to get the full manuscript from the Canadian Medical Association Journal, including the technical appendices that provide detailed sensitivity analyses to show you what kind of parameters have the biggest impact on the cost to government.
To be clear about how you can direct a pharmacare system toward the best-case scenario, our model held the conservative assumption that the public program would fund virtually every medicine in virtually every drug class, which no comparable health system in the world does. We decided we'd throw it all in as a public benefit under this plan. The truth is the public plan would make judicious choices as to which medicines would be covered. The starting point might be the common formulary, or at least the common drugs that are on formularies across Canada. If you did that, you would immediately reduce the incremental cost to government of running a national plan and of expanding coverage to all citizens.
The other thing we did in this model, particularly in the worst-case scenario for government, is we assumed there would be virtually no copayments in the worst-case scenario, which again is something that no province in Canada currently does for general beneficiaries, and in fact, only a few countries around the world do, notably Scotland and Wales, which provide universal coverage at no copayments. If you wanted to limit the public expenditure on a universal public pharmacare program, you would devise a carefully chosen formulary and you would have patients make some contribution toward their prescription costs with notable exceptions for low-income individuals or people with chronic disease. For those of us who have moderate to middle incomes, we might pay $15 or $25 per prescription under the universal drug plan, and indeed, we might continue to have a parallel private insurance benefit to cover the costs of those prescriptions. So it would also be an opportunity to keep costs down under the public plan while still having some viable market for the private insurers either to cover the $15 or $20 copayments or to cover medicines that just didn't make the mark because they weren't proven value for money.