Thank you.
Good morning, and thank you, Mr. Chair and committee members, for inviting me to speak with you as you explore the development of a national pharmacare program.
I'm a fourth year medical student at the University of Saskatchewan's College of Medicine, and I'm currently serving as the vice-president of government affairs for the Canadian Federation of Medical Students.
The CFMS represents over 8,000 medical students from 15 medical schools in Canada. In total there are 17, and the Fédération médicale étudiante du Québec represents the rest of those students. As the national voice of Canadian medical students, our mission at the CFMS is to connect, support, and represent our membership as we learn to serve patients and society.
The CFMS is grateful to be here to present our medical student perspective on the issue of pharmacare. It is our hope that in conjunction with other stakeholders we will be able to inform the body's final recommendations to Parliament.
Let it be known that the CFMS strongly recommends public universal single payer pharmaceutical insurance that will help our future patients to access the medications they need through an evidence-based and cost-effective system.
To highlight some of the problems with the current system, we've focused on the fragmented coverage and the exorbitant costs. Canada is the only nation in the Organization for Economic Cooperation and Development, OECD, with a universal health care system and no corresponding universal pharmaceutical coverage.
Outpatient pharmaceutical costs are covered by a combination of public, private, and out-of-pocket sources, and vary widely between regions and individuals. This fragmented system is financially untenable. Our annual rise in prescription drug expenditures is increasing faster than any other country in the OECD, and our medication prices are among the highest in the world, approximately 30% above the OECD average. Due to the relatively low proportion of public funding of pharmaceutical expenses, these costs come out of the pockets of your constituents and our future patients. Under the current state of affairs, one in 10 Canadians cannot afford their prescribed medications, with an even higher rate for low-income households.
As outpatient pharmaceutical therapy in many cases presents, replaces, or has come to complement the in-hospital treatment that our publicly funded system was created to cover, it's clear that a move toward covering outpatient pharmaceutical therapy is needed to keep our health care responsive to patient needs. Quality patient care does not stop at the hospital door, but ensures continuing care in the community.
For benefits that we see for pharmacare's access to medicines, the 2013 C.D. Howe Institute's report examined medication compliance in jurisdictions with different out-of-pocket costs and showed that a lower cost leads to a greater adherence to medication. By far the greatest compliance is in the U.K. and in the Netherlands where coverage is universal and copays are very low.
There is also safe and evidence-based prescribing that will come with pharmacare. Creating a national formulary of insured medications would help standardize practices and ensure that Canadians are being prescribed safe, effective, and evidence-based therapies from coast to coast to coast. It should be noted that best evidence prescription guidelines have cost-effectiveness as a key component in their creation. As such, covering necessary medications does not mean covering new and expensive drugs in most cases. Having a national pharmacare program would inform research aimed at improving prescription practices and ultimately would save costs.
On lower costs to the system, administrative costs of private health insurance amount to 15% of the total cost in Canada compared to 3.2% for publicly administered health care. Moving to a single payer system in Canada would save up to $1.3 billion, by some studies, abolishing the need for advertising in the private insurance market.
Another analysis showed that the government could expect the most likely base cost increase—and I know you've heard from Dr. Martin and Dr. Morgan—of about $1 billion, which the authors did not view as prohibitive to justifying a single payer pharmaceutical model. Employers and other providers of private medication coverage would save up to $8.2 billion according to the same recent analysis. In total, the net savings on prescription medication would decrease by $7.3 billion with that plan in the study from Morgan et al.
To highlight the medical learner perspective, and where the medical students are coming on this issue, we find that it's a cognitive dissonance that we have to reconcile the true state of access to medicines in this country with what we're taught in medical school. We're taught that in Canada all persons should have access to the care they need, that every life is equally precious, and that it's our role to treat patients in accordance with the most up-to-date principles of science and evidence.
However, as we move out of the classroom into the wards and into practice, we witness our professors and mentors spending hours fighting for patients, advocating for their access to needed medications. We also see that our future practice will in many cases be defined by something we are not really trained to do, which is trying to work around the system in order to ensure access for our patients.
What is worse is that the outcomes of these advocacy efforts are neither consistent nor sustainable. For every patient we are able to help, we know there are many we will not. This generates an added level of professional stress, which is not conducive to physician or system wellness and will ultimately impair our ability to deliver the quality care all patients deserve. A national pharmacare program would help mitigate these problems and allow us to focus on what is most important: treating our patients.
Personally, I recently had a disheartening experience. A patient I was seeing in clinic had not been in to see his physician for over two years, which is totally normal for a 40-year-old male. However, this patient is a type 2 diabetic and needs routine screening. I asked what was keeping him away for so long. The last time he had been in, he was going through a divorce. He had since lost his job and ultimately could not afford his medications. He was now back, two years later, with a job that covered his health expenses through the company's health insurance plan. As you can imagine, he had many negative consequences from two years of non-compliance with diabetes medication: weight gain, high cholesterol, vision problems, and the list goes on. The implications of that to the health care system in the future are something I haven't calculated, but I know it would be quite high.
Unfortunately, medical students hear stories like mine all too often, when we are on the wards, in our discussions with preceptors, and in conversations with our peers. It is difficult to reconcile the treatment protocol we learn in class, as learners, with what we are asked to practice in the community. We learn which medications have the best evidence for treatment, yet when we practice in the community, we must learn a new set of prescribing skills, which includes looking for the cheapest cost and the drugs that our patients can actually afford.
Our organization's position is that students across the country are passionate about the issue. For the past few years, our organization has chosen pharmacare to be the focus of our advocacy efforts. As many of you are aware, or I hope you are, we hold an annual lobby day on the Hill. Both in November 2014 and February 2016 we came to discuss pharmacare with the members.
Furthermore, we have launched a campaign called “Humans of Pharmacare,” where we are gathering ideas and stories from physicians, pharmacists, medical students, allied health professionals, and patients about how our current system is negatively impacting the quality of health care delivery.
In the spring of 2015, our organization passed a motion entitled “Pharmacare: Promoting Equitable Access to Medications”, which can be viewed in its entirety on our website. The four key recommendations from that paper are as follows:
Number one, the Government of Canada should establish an evidence-based national formulary of safe, efficacious, and cost-effective medications.
Number two, the Government of Canada or a pan-Canadian agency should support bulk purchasing for all medically necessary medications. Since that publication, the federal government has joined the pCPA. Although there is sure to be an increase in savings on top of the $490 million, with the federal government being a part of it, the pCPA is far from a perfect solution. Public insurance plans cover only 42% of national medication costs, and coordination between provinces is a complicated process. The pCPA has significant natural and logistical limitations as well. With the consolidation of a fragmented system of coverage into a single purchaser for the country, we can expect increased purchasing power to drive down prescription costs.
Number three, the Government of Canada should support the development of a public, universal, single-payer pharmaceutical insurance, as I highlighted at the beginning.
Number four is that we want to see collaboration between medical education stakeholders in Canada to ensure that the implementation of pharmacare is accompanied by renewed educational efforts for evidence-based prescribing, which is an important piece of this.
Our membership has spoken loud and clear. Pharmacare is important to the future physicians of this country, those of us who will be taking on writing prescriptions and treating patients in the years to come. Public, universal, single-payer pharmaceutical insurance is needed in Canada, and any other manifestation of the same would be a disservice to our patients and society. Pharmacare truly is the missing piece to Canada's universal health care system.
Thank you very much. We look forward to your recommendations.
