Is the fog starting to lift around national pharmacare?
If Missouri is the “Show Me State”, HESA could be forgiven for being thought of as the “Show Me Committee” – at least when it comes to its examination of the Government of Canada’s national pharmacare legislation and what it could mean for patients living with diabetes. In recent hearings, the degree to which legislators and stakeholders alike sought clarity as to what exactly the government meant by national pharmacare and how it planned to proceed, made it clear that uncertainty was the only thing that was clear when it came to pharmacare.
And, it’s not surprising, given the degree of confusion expressed by stakeholders, experts, and parliamentarians alike when it comes to the Government of Canada’s national pharmacare legislation, Bill C-64, which passed third reading in the House of Commons last week.
The lack of clarity is a major concern for diabetes patients, given that diabetes has been the focus of the government’s first phase of its roll-out of its universal pharmacare plan.
For one, the government’s proposed list of diabetes medicines represents just a small fraction of diabetes medications on the market today, with some of the most important diabetes medications missing altogether and representing a major misalignment from published, evidence-based, guidelines. In oral testimony and written briefs from those working to improve access to diabetes medications, significant questions were raised about how the government’s plan might impact on the availability of excluded products, could exacerbate drug shortages which are already an issue for diabetes medications and, indeed,generally make things worse for the 70% of Canadians who already access their diabetes medicines through private insurance.
For some time, Canada’s approach to national pharmacare and, in particular, Bill C-64, has been a kind of Rorsarch Test for the entire community of health leaders and patient advocates. The Swiss physiciatrist and psychoanalyst, Hermann Rorshach, of course became famous for his famous inkblot tests which now bear his name. Those tests famously were designed to reflect the unconscious parts of one’s personality by encouraging a kind of projection of one’s inner self onto the visual stimuli represented by the nondescript inkblots. One could be forgiven for making the connection upon stumbling upon the transcripts from the debate and various witness testimony at HESA.
It truly is difficult to believe that everyone is speaking about the same piece of legislation. The degree to which we simultaneously see people’s greatest hopes, as well as their most dreaded fears, projected on to the map of Canada’s three-page national pharmacare legislation is a wonder to behold.Pharmacare either represents the dawning of a whole new era for improved patient access or a nightmare waiting to unravel. “Trust us,” seems to be the government’s response, as it punts the answers to many of the questions to future decisions yet to be made.
Fortunately, however, the fog may be lifting somewhat, thanks to health minister Mark Holland’s appearance before the committee. For one, it is clear that – whatever rhetoric one might use – the approach to national pharmacare will not be universal, single-payor, nor will it truly be national. Instead, if Holland is to be taken at his word, what we should expect to see is a series of bilateral agreements with provincial governments designed to enhance access to diabetes medicines (and devices), along with contraceptives, for that province’s population. And while it appears that a national formulary may establish a minimum standard for coverage (a bare bones “burlap cloak” as it was described at committee), the expectation is that provincial public plans would go beyond that and that private insurance coverage could continue to provide and augment what public plans will offer.
Whether it accomplishes all this, without undermining existing coverage and wildly distorting the overall market for diabetes medications and devices in Canada, remains to be seen: too much of what Minister Holland is describing is dependent upon negotiations with the provinces which, he claims,he cannot begin until Bill C-64 is proclaimed into law. While there is still much that is unknown, at the very least, the minister’s comments at committee do appear to provide some clarity around the edges. That is a welcome development, indeed.
View Minister Holland’s remarks at Committee here
For transcripts of witness testimony or to access the 36 written briefs submitted to the committee, please click here
