Pharmacare may appeal to premiers seeking consensus this week in N.B.

Eric Hoskins gives Canada's premiers credit for being the catalyst for his current mission.

The physician and humanitarian aid worker — who most recently served as Ontario's health minister — was named last February to head a federal advisory council on how to implement a national pharmacare program.

Implement is the key word in that sentence. Canada has talked about the need for a national drug benefit program for years, even decades. Things now appear to have moved on to a different question: How?

"I'll thank the premiers for their leadership on this issue," Hoskins told CBC News, previewing the remarks he's scheduled to make at a roundtable breakfast on pharmacare Friday on the sidelines of the Council of the Federation talks in Saint Andrews, N.B. "[The council] really is responsible for elevating this to a higher level."

Canada's premiers have been calling for a national pharmacare program since 2004. But after some early progress working with Paul Martin's Liberal government, the concept stalled through Stephen Harper's 10-year tenure. 

At last summer's meeting in Edmonton, the premiers' closing statement called on the federal government to start working on a national pharmacare plan.

That's where Hoskins comes in.

He's spending his summer talking to provincial and territorial ministers and officials — some just recently his colleagues — as well as medical professional, labour and patient advocacy groups.

"I would describe the response of the health ministers as cautious optimism," he said.

Optimistic because they all want to be involved in the process, he said, but cautious because no one knows what the eventual model might look like and how much it might cost.

Is Ontario still onside?

One of the first announcements from Ontario Premier Doug Ford's new Progressive Conservative government cut provincial drug coverage for kids and young adults already covered by private drug plans.

It saves Ontario taxpayers money. But is it also a sign Ontario is now less enthusiastic about universal pharmacare than the previous provincial Liberal government under which Hoskins served?

Hoskins said he met with Ontario's new health minister, Christine Elliott, last Friday and came away very happy with the conversation and her commitment to his work. "I was gratified to get her support," he said.

But it's early days — and no model has been been chosen yet. 

What's he hearing so far in his listening tour? Hoskins said provinces "expect any national pharmacare program to enhance the access to drugs to their population, not take that access away — and I fully agree with that."

And that's the crux of his challenge: the mix of drug benefit programs offered across Canada gives some people more coverage than others, depending on where they live. To be successful, Hoskins must propose a system that helps everyone more equally, at hopefully a lower cost — or at least one people are prepared to pay. 

"I'm confident that we'll create a model that suits Canada," he said.

Hoskins said he's looking to create something that will cross party lines and be built to last — even if it takes a few years for every province to sign on, just like the early days of Canada's medicare system.

"If we do our job right, it should not be dependent on one government or another government, one province or another province," he said.

By the fall, his team will begin crunching data and figuring out what models might work. His final advice to the federal ministers of health and finance is due next spring.

It's a short timeline, he admits, but it's also something that's been studied for a long time already.

'Not all on the same wavelength'

While other items on the Council of the Federation's agenda threaten to split premiers into rival camps — the Trans Mountain pipeline, for example, or the issue of a carbon tax — their talks on Friday, focused primarily on health care issues, like the opioid crisis and joint procurement of high-tech medical equipment, could yield a greater consensus.

"Consensus is a big word," said Linda Silas, president of the Canadian Federation of Nurses Unions (CFNU) that's organizing Friday's breakfast. "The only consensus we have is that something has to be done."

The public health advocacy group has organized similar breakfasts for the last few years, and while not every premier attends, the majority do.

Also speaking at this year's roundtable is former parliamentary budget officer Kevin Page, whose Institute of Fiscal Studies and Democracy released new research on pharmacare this week.

Liberal MP John Oliver, a former health care executive who now sits on the House of Commons standing committee on health, will also speak on his committee's recommendations from last spring.

"To be honest, they're not all on the same wavelength on what has to be done," Silas said.

"It's a political decision: On Friday our job is to convince the 13 premiers that you need to stick together and make sure your role in delivering health care includes making sure that patients get the prescriptions they need."

Research released by her organization last spring suggests more than 1,000 patients with heart disease and diabetes may die prematurely every year from not taking the medication they need because of its cost.

"Patients are actually dying because we don't have a system," she said. 

$62B 'wasted'

While there are no easy solutions, Hoskins has made it clear what kind of work is required, Silas said. He's telling stakeholders not to submit another paper saying why we need pharmacare, she said.

"We know that," Silas said. "Come with a paper to tell us how to do it."

As for the cost, an earlier report released by the CFNU said Canada wasted $62 billion between 2006 and 2015 because it didn't have a co-ordinated pharmacare program. 

When the premiers realize this, Silas said, the need for change should be obvious.

"How do we rejig it so that we cover it the right way?" she said. "Right now we're making big pharma rich, and the insurance companies. Like, really?"