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Pharmaceutical Policy in Canada:Reflections on a Shifting Landscape
Steve Morgan, PhDCentre for Health Services and Policy Research
University of British Columbia
T H E
C O M M O N W E A L T H
F U N D
Centre forHEALTH SERVICES AND POLICY RESEARCH
Canadian “Medicare”
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Canadian Pharmacare
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The coverage landscape:Under- and Un-insured for Routine Drug Costs
0%
10%
20%
30%
40%
50%
CAN BC AB SK MB
ONQC NB NS PE NF
Uninsured Under Insured
Source: Applied Management (2000) "Canadians’ Access to Insurance for Prescription Medicines Volume 2”
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The coverage landscape: Under- and Un-insured for Catastrophic Costs
0%
10%
20%
30%
40%
50%
CAN BC AB SK MB ON
QC NB NS PE NF
Uninsured Under Insured
Source: Applied Management (2000) "Canadians’ Access to Insurance for Prescription Medicines Volume 2”
Centre forHEALTH SERVICES AND POLICY RESEARCH
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1933 1943 1953 1963 1973 1983 1993
Medical & Pharmaceutical Products Retail Rx
Drug Spending as % of GDP
The financial landscape
Source: CIHI and Statistics Canada
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The result, a national pastime…
Provincial Inquiries– New Brunswick– Saskatchewan– British Columbia
National Inquiries– Romanow– Kirby– National Forum on Health– House of Commons
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What has been recommend?
• National Standards for Coverage– First-dollar coverage for vulnerable
– Catastrophic coverage for all Canadians
– Disease management coverage
• National agency/network– Drug regulation
– Drug policy
– Outcomes and policy research
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What are policy makers seeing?
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The Shifting Landscape?
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0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1933 1943 1953 1963 1973 1983 1993
Medical & Pharmaceutical Products Retail Rx
Drug Spending as % of GDP
The financial landscape
Source: CIHI and Statistics Canada
Centre forHEALTH SERVICES AND POLICY RESEARCH
The demographic landscape
Source: Statistics Canada
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What are policy makers doing?
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Coverage (…progress?)
• Provinces agreed to “reasonable coverage” against catastrophic drug costs
• At the same time…– BC eliminated seniors plan universal
income-based plan– Manitoba increased deductibles under its
income-based plan– Ontario backed down on income-based
plan (for now)
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Drug Cost Control (the good news)
• Common Drug Review– Coordinated HTA for new drugs– High standards of evidence (for now)– Provinces retain coverage-decisions
• Outcomes-Based Coverage– Now in BC, NS, MB, SK …
• Utilization Initiatives– Data NPDUIS– Analysis COMPUS– Provincial Agencies Quebec “Medicines Council”
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Thank you