Is Ottawa competent enough to design an efficient and effective national pharmacare program?

A Trudeau government advisory council released a report last week outlining the “foundational” elements for a national pharmacare program, which may be mentioned in next week’s federal budget and be central to the Liberal reelection campaign in the fall. According to other recent reports, some Canadians (ranging from 8.2 per cent to 23 per cent) struggle to pay for medications.

The obvious question should be—how can we help these specific Canadians? But it seems the Trudeau government has something much more ambitious—but not necessarily efficient—in mind.

Last week’s advisory council report calls for the creation of a national drug agency “to manage and oversee national pharmacare.” Yet it’s unclear why this agency, which, among other tasks, would assess health technologies and negotiate drug prices with manufacturers, is necessary. Several agencies including the little-known pan-Canadian Pharmaceutical Alliance and the Patented Medicine Prices Review Board already do this work. And incidentally, research indicates these organizations actually limit access to new drugs, especially expensive ones, in Canada. Their amalgamation into one large agency may further limit the ability of Canadians to access potentially life-changing (or lifesaving) drugs. Bigger isn’t always better.

The report also calls for the creation of a national formulary—essentially a list of preferred drugs—with "evidence-based" value according to government. It's unclear whether this will mean a basic formulary of a few hundred "essential" drugs or something much greater, but it’s extremely unlikely to match the comprehensive lists of drugs covered by private insurance plans.

So while there may be evidence that vulnerable groups of Canadians should have access to a formulary of essential medications with low (or no) co-payments (which is already the case in many provinces), the need to establish such a list for all Canadians—including the vast majority who can afford their prescriptions (either individually or through private insurers)—is less clear.

Finally, the report recommends creating a data system to keep track of drugs. There may be some merit to such a system, as much time and effort is spent trying to evaluate the value of drugs before they are widely marketed. But insufficient effort is spent evaluating whether the drugs work as intended and improve patient health outcomes. Of course, the ability (and appropriateness) of the federal government to establish and maintain such a system is a point for consideration.

Given the lack of detail, it’s unclear whether last week’s report will make matters worse or, at best, end up a wastefully expensive exercise that yields little benefit for patients. What’s clear, however, is that the report’s proposals are likely unnecessary. In fact, the only real takeaway is that there’s general agreement in Ottawa that bigger bureaucracies are better and that the federal government is somehow competent enough to tell provinces how to design pharmacare plans for their residents. We may learn more about the government’s intentions on budget day next Tuesday.