The first thing you need is an evidence-based formulary. Prescribing habits must be based on evidence-based medicine, not on the promotional campaigns of drug companies. This is very important.
In terms of these conflicts of interest, for example, we're talking a lot about the opioid crisis right now. Keep in mind that you have this huge promotional campaign by a drug company that was basically providing claims that were bullshit. They had to pay $20 million because they were false claims. As soon as oxycontin was out, the attitude of private coverage was that we don't do any clinical assessments. It's approved by Health Canada, so we're covering it as fast as possible. Fantastic.
When we discover there is a problem, what can we do about it? Right now we don't even have the databases to understand what is being prescribed, where, by whom, or for which condition, and these are essential tools if we want to maintain a system based on evidence-based medicine instead of the promotional campaigns of the drug companies.
For me, universal pharmacare is also a way to develop institutional tools in terms of monitoring what is going on instead of saying that the drug is new, so let's go as fast as possible and we need to reimburse. No. We need to understand what this drug is doing. Is it a good product or not? How much do we pay for it? If there's no cap, if there are no standards to define this, then you end up with an open floor.
Keep in mind Steve's example of two guys going to the car dealer. What happens if every day exactly the same guys go to the car dealer? Will the car dealer provide a much better car at a lower price in the long run, or basically a scrappy car with a very high price? This is exactly what we have right now. Some drug companies focus on private plans. I include Valeant, because it is clear in their annual report every year that they focus on private plans, because there is no health technology assessment, so basically there is no cost pressure. They focus on them because they know that they will not be bothered with price sensitivity.
This is exactly the type of market we're developing with drug companies right now, and that's a huge problem. If you want a system that works well, if you want drug companies to do research on new products that do provide real benefits to the population, you need an evidence-based formulary for everyone.