Rather than nationalizing pharmacare, policymakers should simply improve our current systems

At a recent gathering in Saskatchewan, Canada’s 13 premiers released a joint statement on national pharmacare, asserting their authority over the “design and delivery” of any prescription drug program and their right to opt out of whatever plan Ottawa may implement.

To understand why, it’s important to clarify the realities of current coverage available to Canadians composed of a vast network of provincial plans to help Canadians, particularly vulnerable groups, with the costs of prescription medications.

In Alberta, for example, just about everyone under the age of 65 can enroll in the province’s Non-Group Coverage plan. Under this plan, families must pay a $118 monthly premium and 30 per cent of their prescription costs (up to a $25 maximum). Lower-income groups receive premium subsidies while seniors are exempt from premium payments (but still must pay the 30 per cent co-pay). And that’s not all, other programs cover the full cost for very low-income Albertans, those who are severely disabled and on social assistance.

Yet despite these plans in Alberta and similar programs in other provinces, some Canadians (8 per cent, 11 per cent or 23 per cent depending on the data source) struggle to pay for prescription drugs. But that doesn’t necessarily mean we should create a national federally-run pharmacare system (something the Trudeau government is considering). If anything, our first priority should be to identify these Canadians and help them take full advantage of existing programs.

While proponents of a national system often point to Australia and the United Kingdom (which rely heavily on government programs), they seem willfully ignorant of countries such as Switzerland and the Netherlands, which provide universal coverage for pharmaceuticals by embracing the private sector as a partner. In both countries, individuals must buy insurance for all health-care services (including pharmaceuticals) from private providers in a regulated—but competitive—market, with subsidies for low-income groups and exemptions for vulnerable populations. But otherwise patients share the cost of treatment (or prescription) up to an annual maximum.

Crucially, while both countries spend about the same as we do on health care (Switzerland a bit more, the Netherlands a bit less) they perform markedly better in terms of the availability of physicians, beds, MRI scanners and, critically for Canadians, they have much shorter wait times.

But we don’t need to look overseas for interesting examples of drug plans in action. In Quebec, residents are required to have prescription drug insurance. If they are eligible for a private plan, they must enroll. If they are ineligible for a private plan, they may register for the government’s drug insurance plan (RAMQ), pay premiums and share the cost of prescriptions.

Moreover, Quebec’s private plans must offer benefits equivalent to the public plan and are a fundamental part of Quebec’s universal pharmacare system. The resulting mixed public-private system provides generous coverage to all Quebecers regardless of income (in fact, Quebec’s public plan is more generous and provides access to newer drugs faster than anywhere else in the country)—a far cry from the government monopoly idea being considered in Ottawa.

There’s clear evidence some Canadians struggle to pay for their prescriptions. If policymakers want to help these Canadians, they should first ensure that those who are struggling can take full advantage of existing programs. If necessary, those same policymakers should alter those programs to improve coverage and examine how private insurers can help deliver the promise of universal pharmacare.