Good afternoon, Mr. Chair and committee members.
First, thank you for the opportunity to appear as a witness on this important discussion. I am Natasha Mistry, director of stakeholder relations and community development at CARP.
CARP is a non-profit organization committed to enhancing financial security and improving health care for Canadians as they age. I am here today representing the more than 300,000 CARP members across the country, and to share the perspectives of retirees, seniors, and older Canadians. CARP has long believed that Canadian drug policies need improvement. The status quo is no longer a sustainable option. Reform is required to ensure that drugs are affordable and accessible to Canadians regardless of age, income, and geography. When used appropriately, these medications help seniors manage their conditions.
For example, drugs for MS patients slow down the progression of disease and ward off the advancement of physical disabilities. For people living with inflammatory bowel disease, specialty medications, such as biologics, have increased remission rates, reduced hospitalizations, and postponed the need for surgery—surgery that entails removing large sections of their gastrointestinal tract.
Seniors, especially those living with chronic health conditions, comorbidities, and disease, face challenges in accessing the medications they need. Among CARP members, 10% have admitted to skipping prescription medications because of costs. In 2014 a CARP survey on pharmacare revealed that 85% of CARP members have drug coverage. Nearly half, at 49%, commonly held private plans, and 28% received drug coverage through provincial plans. However, approximately 700,000 Canadians have no insurance coverage at all. Regardless of private or public coverage, the vast majority of CARP members support the development of a national pharmacare program. Access and affordability are key factors in ensuring better health care outcomes for all Canadians.
At CARP we have the following three recommendations for improvements: one, create national pharmacare standards; two, facilitate bulk buying to reduce costs; and three, have the federal government lead this process.
Recommendation one is to create national standards for pharmacare. Roughly 11 million Canadians are eligible to receive drug coverage through one of 19 provincial and federal public drug programs. Prescription drugs in Canada are currently financed by a fragmented patchwork of public and private drug formularies that vary by province. Each province manages its own health and drug plan. This results in varying programs for drug coverage across the country, with Ontario and the Atlantic provinces as the few that continue to provide public pharmacare coverage specifically for seniors.
As the boomer generation transitions from private to public plans, they place greater pressure on existing provincial drug budgets. This was a key instigator in B.C.'s decision to move from an age-based program to an income-based one. Private coverage too has its challenges, and it should not be assumed that private insurance provides sufficient coverage. To further complicate matters, approximately 40% of Canadians lack adequate private coverage for reasons of being self-employed or underemployed. For people living with chronic conditions or illnesses, insurance companies will often attach higher premiums or even decline applications in order to balance the cost of the benefits against the risks assumed by the insurer.
Recommendation two is to facilitate bulk buying to reduce costs. CARP members are in favour of national drug purchasing as the best way to bring down the cost of drugs. CARP supports the work of the pan-Canadian Pharmaceutical Alliance to jointly negotiate and help lower the cost of treatments. We appreciate the sophistication with which these negotiations take place; however, we encourage decisions to be made on a timely basis and financial challenges not to delay access. The way it stands, pharmaceutical costs should not be viewed in a silo, but instead be integrated into the health care system. In reality, provincial drug programs are kept separate from other health care budgets.
This makes it harder to evaluate the real value of drugs or the health care savings that result from pharmaceutical compliance. Because data on the cost of drugs and the cost of other health care are separate, the benefits of drug access will not be accounted for in understanding their impact and savings to the overall provincial health budget. We understand that provinces face difficult financial situations, and we all need to ensure that health care expenditures are judicious, with demonstrated improvements and outcomes.
With new technologies, drugs are lowering hospitalizations, surgeries, and emergency visits. Standardization and the creation of robust formularies are a way to achieve universal access no matter where Canadians reside. Without standards, drug access will continue to hinder access.
For example, the Gastrointestinal Society, together with Crohn's and Colitis Canada, recently produced a report card that graded provinces on access to biologic treatments for people with inflammatory bowel disease. The report card showed that because of varying criteria and formularies, access was inequitable in different provinces for people with gastrointestinal disease. Worse yet, in order to get access, gastroenterologists have expressed the desire to misdiagnose patients in order for them to quality for treatments gastroenterologists believe would help their patients achieve remission. This example demonstrates how formularies are out of step with the medical needs of patients.
The same drugs at the same price should be covered in every province and territory. Uniform standards among provincial catastrophic drug programs and public drug formularies are necessary to achieve equity. However, these standards must be robust and not merely reach minimum levels of drug coverage. There should be no race to the bottom. We must carefully review the best practices, the best criteria, and the best formularies to ensure adequate coverage and options. Patient choice must be made available to allow Canadians the most appropriate treatment.
To do this, governments, both provincial and federal, should work with medical practitioners and patients to devise appropriate standards for provincial catastrophic plans and formularies. The federal government should partner with provinces and territories to create a robust set of conditions that make drugs accessible.
This leads me to CARP's third recommendation: federal leadership for a pan-Canadian approach. CARP believes that creating a national pharmacare plan would require governments to jointly negotiate prices and access with private-sector insurers and pharmaceutical manufacturers. The federal government has a responsibility to play a strong role in the development of a national pharmacare plan. CARP has been recommending universal pharmacare for many years, calling on the federal and provincial governments to work together in the best interests of Canadians. We look to an expanded role for the federal government, one in which it would co-operate with provincial counterparts in creating the best plan possible.
As you have most likely heard from witnesses before me, Canada is the only country with a universal health care system that lacks universal coverage for prescription drugs. We need to do better, and the time is now. Each of you as a committee member has a crucial role to play in setting the course for the future of Canadian pharmacare. I urge you to devise recommendations that help to enhance pharmacare and that will allow our decision-makers to take these recommendations and implement change.
Thank you.