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National pharmacare – might it be a pig in a poke?

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From the Macdonald Laurier Institute

By Nigel Rawson and John Adams for Inside Policy

No Canadian should have to choose between paying for medicines and paying for rent or food. National pharmacare has been proposed as a remedy to this situation.

“When will Canada have national pharmacare?” asks the author of a recent article in the British Medical Journal (BMJ). Better questions are: will Canadian pharmacare be the system many Canadians hope for? Or, might it turn out to be skimpy coverage akin to minimum wage laws?

In its 2024 budget document, the federal government proposed providing $1.5 billion over five years to support the launch of national pharmacare for “universal, single-payer coverage for a number of contraception and diabetes medications.” This has been hailed as a “big day for pharmacare” by some labour unions, patients and others, including the author of the BMJ article who said that national pharmacare should be expanded to cover all medication needs beginning with the most commonly-prescribed, clinically-important “essential medicines.”

In its budget, the government stated “coverage of contraceptives will mean that nine million women in Canada will have better access to contraception” and “improving access to diabetes medications will help improve the health of 3.7 million Canadians with diabetes.” Why not salute such affable, motherhood and apple pie, sentiments? The devil is in the details.

The plan does not cover new drugs for diabetes, such as Ozempic, Rybelsus, Wegovy, Mounjaro or Zepbound, all based on innovative GLP-1 agonists, where evidence is building for cardiovascular and weight loss benefits. This limited rollout seems based on cheap, older medicines, which can be less effective for some with diabetes.

The federal government has also consistently under-estimated the cost of national proposals such as pharmacare – not to mention other promises. In their 2019 election platform, the Liberals promised $6 billion for national pharmacare (the NDP promised $10 billion). Keen analysis shows that even these expansive amounts would be woefully inadequate to fund a full national pharmacare plan. This makes the $300 million a year actually proposed by the Liberals’ look like the skimpy window-dressing that it is.

National pharmacare, based on the most comprehensive existing public drug plan (Quebec’s), would cost much more. In 2017, using optimistic assumptions, the Parliamentary Budget Officer (PBO) estimated the cost for a national plan based on Quebec’s experience to be $19.3 billion a year. With more appropriate assumptions, the Canadian Health Policy Institute estimated $26.2 billion. In June 2019, the federal government’s own Advisory Council on the Implementation of National Pharmacare put the cost at $40 billion, while a few months later, the tax consulting company RSM Canada projected $48.3 to $52.5 billion per year. Five years later, costs no doubt have soared.

Even with these staggering cost a program based on matching Quebec’s drug plan at the national level would fail to provide anywhere near the level of coverage already provided to the almost two-thirds of Canadians who have private drug insurance, including many in unionized jobs. Are they willing to sacrifice their superior coverage, especially of innovative brand-name medicines, for a program covering only “essential medicines”? Put another way, are Canadians and their unions prepared to settle for the equivalent of a minimum wage or minimum benefits?

The PBO has estimated the cost of coverage of a range of contraceptives and diabetes medicines as $1.9 billion over five years, which is more than the $1.5 billion provided in the budget. However, this figure is based on an assumption that the new program would only cover Canadians who currently do not have public or private drug plan insurance, those who currently do not fill their prescriptions due to cost related reasons, and the out-of-pocket part of prescription costs for Canadians who have public or private drug plan coverage. This is major guesswork because existing public and private drug plans may see the new federal program as an opportunity to reduce their costs by requiring their beneficiaries to use the new program. If this occurs, the national pharmacare costs to the federal government, even for the limited role out of diabetes and contraceptives, would soar to an estimated $5.7 billion, according to the PBO.

Our governments are not known for accurate estimates of the costs of new programs. One has only to remember the Phoenix pay system and the ArriveCAN costs. In 2017, the Government of Ontario estimated $465 million per year to extend drug coverage to every resident under the age of 25 years. What happened? Introduced in 2018, prescriptions rose by 290% and drug expenditure increased to $839 million – almost double the guesstimate. In 2019, the provincial government back peddled and modified the program to cover only people not already insured by a private plan.

Although we believe governments should facilitate access to necessary medicines for Canadians who cannot afford their medicines, this does not require national pharmacare and a growing bureaucracy. Exempting lower-income Canadians from copayments and premiums required by provincial programs, as British Columbia has done, and removing the requirement to pay for all drugs up to a deductible would allow these Canadians access sooner, more simply, and more effectively.

Moreover, it isn’t just lower-income Canadians who want help with unmet medicine needs. Canadians who need access to drugs for diseases that are difficult to treat and can cost hundreds of thousands of dollars per year also require assistance. Few Canadians whether they have low, medium or high incomes can afford these prices without government or private insurance. Private insurers often refuse to cover these drugs.

The Liberals provided a separate $1.5 billion over three years for drugs for rare disorders, but no province or territory has signed a bilateral agreement with the federal government for these drugs and no patient has received benefit through this program. Even if they did, the $500 million per year would not go far towards the actual costs. There is at least a zero missing in the federal contribution, as the projected cost of public spending on rare disease medicines by 2025 is more than threefold what Ottawa has budgeted.

Expensive drugs for cancer and rare disorders are just as essential as basic medicines for cardiovascular diseases, diabetes, birth control, and many other common conditions. If a costly medicine will allow a person with a life-shortening disease to live longer or one with a disorder that will be severely disabling left untreated to have an improved quality of life and be a productive taxpayer, it too should be regarded as essential.

The Liberals and NDP are working to stampede the bill to introduce the pharmacare program (Bill C-64) through the legislative process. This includes inviting witnesses over the first long weekend of summer, when many Canadians are away, to appear before the parliamentary Standing Committee on Health three days later.

Too much is unknown about what will be covered (will newer drugs be covered or only older, cheaper medicines?), who will be eligible for coverage (all appropriate Canadians regardless of existing coverage or only those with no present coverage?), and what the real cost will be, including whether a new program focusing on older, cheaper drugs will deter drug developers from launching novel medicines for unmet needs in Canada.

This Bill as it stands is such a power grab that, if passed, the federal Health Minister never has to come back to Parliament for review, oversight or another tranche of legal authority, it would empower the Cabinet to make rules and regulations without parliamentary scrutiny.

A lot is at stake for Canadians, especially for patients and their doctors. Prescription medicines are of critical importance to treating many diseases. National pharmacare must not only allow low-income residents to access purported “essential medicines” but also ensure that patients who need specialized drugs, especially higher-cost innovative cell and genetic therapies that may be the only effective treatment for their disorder, are not ignored. Canadians should be careful what they wish for. They may receive less than they anticipate, and, in fact, many Canadians may be worse off despite the increase in public spending. Time to look under the hood and kick the tires.

Nigel Rawson is a senior fellow with the Macdonald-Laurier Institute.

John Adams is co-founder and CEO of Canadian PKU and Allied Disorders Inc., a senior fellow with the Macdonald-Laurier Institute and volunteer board chair of Best Medicines Coalition.

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RFK Jr. says Hep B vaccine is linked to 1,135% higher autism rate

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From LifeSiteNews

By Matt Lamb

They got rid of all the older children essentially and just had younger children who were too young to be diagnosed and they stratified that, stratified the data

The Centers for Disease Control and Prevention (CDC) found newborn babies who received the Hepatitis B vaccine had 1,135-percent higher autism rates than those who did not or received it later in life, Robert F. Kennedy Jr. told Tucker Carlson recently. However, the CDC practiced “trickery” in its studies on autism so as not to implicate vaccines, Kennedy said.

RFK Jr., who is the current Secretary of Health and Human Services, said the CDC buried the results by manipulating the data. Kennedy has pledged to find the causes of autism, with a particular focus on the role vaccines may play in the rise in rates in the past decades.

The Hepatitis B shot is required by nearly every state in the U.S. for children to attend school, day care, or both. The CDC recommends the jab for all babies at birth, regardless of whether their mother has Hep B, which is easily diagnosable and commonly spread through sexual activity, piercings, and tattoos.

“They kept the study secret and then they manipulated it through five different iterations to try to bury the link and we know how they did it – they got rid of all the older children essentially and just had younger children who were too young to be diagnosed and they stratified that, stratified the data,” Kennedy told Carlson for an episode of the commentator’s podcast. “And they did a lot of other tricks and all of those studies were the subject of those kind of that kind of trickery.”

But now, Kennedy said, the CDC will be conducting real and honest scientific research that follows the highest standards of evidence.

“We’re going to do real science,” Kennedy said. “We’re going to make the databases public for the first time.”

He said the CDC will be compiling records from variety of sources to allow researchers to do better studies on vaccines.

“We’re going to make this data available for independent scientists so everybody can look at it,” the HHS secretary said.

Health and Human Services also said it has put out grant requests for scientists who want to study the issue further.

Carlson asked if the answers would “differ from status quo kind of thinking.”

“I think they will,” Kennedy said. He continued on to say that people “need to stop trusting the experts.”

“We were told at the beginning of COVID ‘don’t look at any data yourself, don’t do any investigation yourself, just trust the experts,”‘ he said.

In a democracy, Kennedy said, we have the “obligation” to “do our own research.”

“That’s the way it should be done,” Kennedy said.

He also reiterated that HHS will return to “gold standard science” and publish the results so everyone can review them.

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RFK Jr. tells Tucker how Big Pharma uses ‘perverse incentives’ to get vaccines approved

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From LifeSiteNews

By Matt Lamb

Kennedy defended his decision to fire all 17 members of the Advisory Committee on Immunization Practices, which he decried as a tool used to “rubber stamp” vaccines.

The vaccine approval process is a “bundle of perverse incentives” since pharmaceutical companies stand to make billions of dollars in revenue from it, Secretary of Health and Human Services Robert F. Kennedy Jr. told Tucker Carlson recently.

Kennedy appeared on Carlson’s show yesterday to discuss a variety of issues, including the potential link between autism and vaccines and his overhauling of the vaccine advisory committee at the Centers for Disease Control and Prevention last month.

Kennedy began by explaining that Big Pharma has been targeting academic journals to ensure its products receive favorable reviews.

“The journals won’t publish anything critical of vaccines … there’s so much pressure on them. They’re funded by pharmaceutical companies, and they’ll lose advertising and revenue from reprints,” Kennedy said.

Kennedy then noted that Big Pharma will “pay to get something published in these journals,” before accusing industry leaders of pushing drugs on doctors and of hiring “mercenary scientists” to manipulate data until their product is deemed safe and effective.

The entire complex is broken due to the “perverse incentives,” he lamented.

Later in the interview, Kennedy defended his decision to fire all 17 members of the Advisory Committee on Immunization Practices (ACIP) in June, which he decried as a mere tool to “rubber stamp” vaccines.

This sort of “agency capture” explains the lucrative nature of vaccines, he added.

Kennedy then summarized the “perverse” process as follows:

First of all, the federal government often times actually designs the vaccine, [the National Institutes of Health] would design it, would hand it over to the pharmaceutical company. The pharmaceutical company then runs it … first through [the] FDA, then through [the] ACIP, and gets it recommended.

If you can get that recommendation you now got a billion dollars in — at least — revenues by the end of the year, every year, forever. So, there was a gold rush to add new vaccines to the schedule and ACIP never turned away a single vaccine … that came to them they recommended, and a lot of these vaccines are for diseases that are not even casually contagious.

Kennedy further pointed to the Hepatitis B shot for newborns as an example of how the industry has been corrupted.

In 1999, the CDC “looked at children who had received the hepatitis vaccine within the first 30 days of life and compared those children to children who had received the vaccine later — or not at all. And they found an 1,135% elevated risk of autism among the vaccinated children. It shocked them. They kept the study secret and manipulated it through five different iterations to try to bury the link,” he said.

“We want to protect public health,” Kennedy explained, but “these vaccines … can cause chronic disease, chronic injuries that last a lifetime.”

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