National Pharmacare: What Do We Know? What Do We Need to Know? W. Neil Palmer

Transcription

1 Healthy Canada Conference 2017: Access to Affordable Medicines Toronto April 2017 National Pharmacare: What Do We Know? What Do We Need to Know? W. Neil Palmer

2 Why National Pharmacare? 1. Universal / comprehensive pharmacare coverage Providing coverage for those with no or inadequate coverage Ability to pay should not be a barrier 2. Equity / equitable access to prescription drugs across Canada National formulary of clinically and cost effective drugs 3. Reducing overall drug expenditures Increased bargaining power should result in lower prices 4. Public Only eliminating private drug insurance Consistent with Canada Health Act principles for medically necessary services April

3 But 1. Universal coverage we don t know the extent of the lack of coverage Estimates are based on limited surveys with poor response rate True rate of inadequate coverage is unknown All jurisdictions have catastrophic coverage (but is it adequate?) 2. Equity / equitable access pan-canadian process already in place and evolving Provincial formularies are > 90% harmonized already CADTH (CDR, pcodr) and pcpa (all public jurisdictions) continue to improve harmonization 3. Reducing drug expenditures mechanisms already in place and evolving National Pharmacare program is not a prerequisite for lower prices or lowering drug expenditures PMPRB, pcpa, private insurers are actively reforming pricing and funding policies to limit drug prices and expenditures how would national pharmacare be any different 4. Public Administration what will be gained by eliminating private drug insurance? Reduced coverage (fewer drugs covered) Private drug plans are an employee benefit (like dental, eye care) April

4 In 2016, ~10% of Canadians did not fill a prescription or skipped doses of medicine Canadian Institute for Health Information. How Canada Compares: Results From The Commonwealth Fund s 2016 International Health Policy Survey of Adults in 11 Countries. Ottawa, ON: CIHI; 2017 What we don t know.. Which drugs? Medically necessary / formulary eligible? How many prescriptions affected? Were alternative meds sought from MD or pharmacist? Did the respondents have drug coverage? Are the responses reliable? No internal verification Are the responses representative of the Canadian population? 4 out 5 did not respond April

5 Despite cost barriers, Rx Drug use higher in Canada Canadian Institute for Health Information. How Canada Compares: Results From The Commonwealth Fund s 2016 International Health Policy Survey of Adults in 11 Countries. Ottawa, ON: CIHI; 2017 April

6 Same survey Cost barriers to accessing MD s, Tests Canadian Institute for Health Information. How Canada Compares: Results From The Commonwealth Fund s 2016 International Health Policy Survey of Adults in 11 Countries. Ottawa, ON: CIHI; 2017 April

7 Income is a factor in accessing even free health care Canadian Institute for Health Information. How Canada Compares: Results From The Commonwealth Fund s 2016 International Health Policy Survey of Adults in 11 Countries. Ottawa, ON: CIHI; 2017 April

8 Timely access to medical care in Canada is poor Last time you were sick or needed medical attention, how quickly could you get a same or next-day appointment to see a doctor or a nurse? Is it very/somewhat easy to get medical care in the evenings, on weekends or on holidays without going to the hospital emergency department? Canadian Institute for Health Information. How Canada Compares: Results From The Commonwealth Fund s 2016 International Health Policy Survey of Adults in 11 Countries. Ottawa, ON: CIHI; 2017 April

9 Summary Inadequate prescription drug coverage is the most important pharmacare issue It is also the issue for which we have the least information Near term: Comprehensive analysis of the coverage gaps is essential for developing pharmacare policies Long term: IT / Database linkages between EMR and prescription drug utilization Access (including cost) barriers appear to exist throughout the health care system further analysis required April

10 Biography W. Neil Palmer Founder & Principal Consultant PDCI Market Access Inc Neil Palmer President and Principal Consultant of PDCI Market Access Inc. (PDCI) a leading pricing and reimbursement consultancy founded in Prior to PDCI, Neil worked with the Canadian Patented Medicine Prices Review Board (PMPRB) where his responsibilities included policy development, overseeing the price review of patented medicines and conducting economic research. Prior to the PMPRB, he worked with the Health Division of Statistics Canada where he was responsible for economic and statistical analysis of health care costs and utilization. Neil also worked with RTI Health Solutions (Research Triangle Park, North Carolina) where he served as global vice president for pricing and reimbursement. After completing his studies at the University of Western Ontario, Neil began his career in Montreal with the research group of the Kellogg Centre for Advanced Studies in Primary Care. He has written extensively on pharmaceutical pricing and reimbursement issues and is a frequent speaker at conferences in North America and Europe. In January 2015, Neil was appointed Adjunct Assistant Professor at the University of Southern California School of Pharmacy graduate program in Health Care Decision Analysis where he is an occasional lecturer on health technology assessment, pricing and market access from a global perspective. April