Universal public coverage of essential drugs would improve health care, research suggests

Governments should pay for essential prescribed medicines for all Canadians in order to improve their health care, new research suggests.

Drugs considered "essential medicines" should be available at all times to everyone who needs them, the researchers say. Examples include insulin, some antibiotics and oral contraceptives.

The World Health Organization introduced the concept of essential medicines, and more than 110 countries have adapted it to their needs. Canada has not, despite a 2012 call from the House of Commons health committee to establish such a list as soon as possible.

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In Monday's issue of the CMAJ Open, an online open-access journal, Dr. Nav Persaud, a family physician at St. Michael's Hospital in Toronto, and his team describe how they developed a preliminary Canadian essential medicines list of 125 drugs.

"If you look at the medications on the list, these are treatments for high blood pressure, diabetes, HIV," Persaud said in an interview. The medications have been shown to save lives.

"We also know that there are people who don't take these medications because of the cost. If you put those two things together, it seems likely that an essential medicines list could improve care and improve life expectancy."

Medications on the list accounted for 44 per cent of all prescriptions filled at retail pharmacies in 2015, the researchers said.

Skipped pills

It's estimated that in Canada, one in 10 people, or about three million, cannot afford prescribed medications.

"I care for people who have come from lower-income countries where they have medication access programs, and then they've been surprised when they came here and didn't have access to medications," Persaud said. 

Persaud said he now prescribes from the shortened list of medicines because it's easy to remember doses and interactions.

In a related study published in CMAJ, researchers propose that governments buy essential medicines in bulk for all of Canada.

Steven Morgan, a professor in the School of Population and Public Health at the University of British Columbia, and his team said adding an essential medicines list would ensure all Canadians have access to the most commonly needed medicines.

Morgan's team estimated savings from universal public coverage of essential medicines of $4.27 billion per year for patients and private drug plan sponsors, at an incremental government cost of $1.23 billion per year. 

"Doing so may be a pragmatic step forward while more comprehensive pharmacare reforms are planned," Morgan and his co-authors concluded.

Unaffordable drugs

More than one in five Canadians report they or someone in their household has skipped doses, split pills or not filled prescriptions to save money on medication in the previous year.

Ada Dominguez, 53, of Toronto, finds it difficult to pay out of pocket for her asthma inhalers, cholesterol-lowering medications and knee pain medications without getting behind on her other bills. When Dominguez was prescribed antibiotics for a pneumonia infection, she couldn't afford it on her own. 

"It's a struggle for me," Dominguez said. "Sometimes I cry because I don't have my medicine. It's not easy to live like this. "

Without the medications,  Dominguez said, she's immobilized.

Amir Attaran, a professor in the law and medicine faculties at the University of Ottawa who has studied drug pricing, believes universal public coverage of essential medicines is possible and desirable. He was not involved in the CMAJ Open research.

'Overpaying is out of control'

"Our price problem in Canada is not with the patented medicines so much as the off-patent, generic ones," Attaran said. "That's where our overpaying is out of control."

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Attaran believes provinces, territories and the federal government could negotiate better deals for generic drugs. 

Dr. Jacalyn Duffin, a hematologist at Queen's University in Kingston, Ont., studies the causes and effects of drug shortages in Canada, and says she's sympathetic to the need for pharmacare.

Duffin called the list of 117 medications an excellent start.

"If the country names these as the drugs we need, and then commits to stocking them and alerting when supplies are low, then it would have huge impact on the chronic generic drug shortage."

Health Minister Jane Philpott said having the public pay for essential medicines would be a reasonable proposal, eventually.

"At this point we have not made a commitment to universal pharmacare, but we have made a commitment towards making sure the cost of medications are lower," Philpott said.

Philpott said the federal government is looking for ways for private payors to also benefit from lower costs, and it is working on a list of essential medicines with provinces and territories.

"Those are all important steps, and if we were someday as a country to be able to have a universal pharmacare program, it would be impossible to get there without doing this important work that we're undertaking."