(O.17) Drug Costs & Pharmacare: Case Study

Question 1

More than __ in __ Canadians said
They/someone in their house didn’t take prescription due to cost

Answer 1

1 in 5

Question 2

On a per person basis, Canada spends the ____nd most on prescriptions in the world (after US)

Answer 2

2nd

Question 3

Government helps some groups pay for their drugs

Answer 3

○ Indigenous people
○ Seniors
○ Residents of Quebec
○ Those on welfare
As of 2018, people under 25 in Ontario

Question 4

T or F: Every developed country in the world that has a universal healthcare system also has universal drug coverage EXCEPT CANADA

Answer 4

T
○ Plan to pay for citizen’s meds through state drug plan
Pharmacare was part of blueprint but never happened

Question 5

T or F: Canadians pay among the highest prices in the world for medication

Answer 5

T

Question 6

T or F: if government had monopoly on drug plans it would increase costs by billions

Answer 6

F: cut costs
○ New Zealand did that (1993) and today some drugs = 90% cheaper than in Canada

Question 7

are Pharmaceuticals deemed as Medically necessary health services covered under 5 different conditions Canada Health Act

Answer 7

hell nah

Question 8

Prescription drug coverage was part of comprehensive national healthcare proposals discussed in Canada as far back as the 1940s, on agenda for decades, yet cannot get it changed. Idea was to do policy in stages:

Answer 8

first hospital insurance, then medical insurance, then drug insurance

…… Haven’t gotten to drug insurance

Question 9

Government was wait for pharmaceutical spending to ______ before expanding medicare to include pharmacare

Answer 9

plateau
- No plateau, prices increased

Question 10

Provinces have tried to make changes since none on federal level - how? (example)

Answer 10

Saskatchewan: universal, comprehensive drug coverage from 1975 through 1987

Question 11

T or F: $$ spent on drugs is one of the lowest allocated expenditures in health spending category

Answer 11

F: $ spent on prescription drugs is tied for 2nd most with physicians, after hospitals

Question 12

Why are drugs so expensive
* 2 main cost drivers

Answer 12

1. Increase in the overall use of prescription drugs (Majority due to volume of units)
2. Use of newer and more costly prescription drugs

Question 13

Canada’s drug prices are the ____ highest among the 38 Organisation for Economic Co-operation and Development (OECD) countries, influencing Canadians’ access to drugs (impacting their health) and the sustainability of Canada’s health care system

Answer 13

3rd

Question 14

_____ million (__ in ____) Canadians either don’t have prescription drug insurance or have inadequate insurance to cover their medication needs

Answer 14

7.5 million
1 in 5

• May have copays/deductibles -> need to pay first 10%

Question 15

____million Canadians do not fill their prescriptions

Answer 15

3

Question 16

T or F: All jurisdictions in Canada provide public drug coverage for seniors aged 65+

Answer 16

T

Question 17

Costs of medicines don’t change dramatically, but ________does

Answer 17

= source of financing

○ Comes from government not employment

Question 18

Governments may choose to avoid public liability associated with an age-based entitlement to drugs and switch to
a. means-tested or
b. catastrophic drug plans

Answer 18

= Means-tested: subsidize drugs depending on your means
- Low income = more subsidy, high income = will not provide free drugs

= Catastrophic drug plan = social safety net
- If disease is severe and costs a lot then they’ll give help

Question 19

T or F: Governments try to address the societal burden of total drug expenditures before choosing to limit public drug expenditures rather than

Answer 19

F: Governments may choose to limit public drug expenditures rather than address the societal burden of total drug expenditures

Question 20

Public drug program spending accounted for _____% of all prescribed drug spending in Canada in 2021, amounting to $___ billion

Answer 20

44%
$16.2

• 44% virtually the same percentage since 1990 = NO CHANGE

Question 21

T or F: Even though many Canadians have some form of coverage, Canada relies on a confusing patchwork of over 100 public prescription drug plans and over 100,000 private plans —with a variety of premiums, copayments, deductibles and annual limit

Answer 21

T

Question 22

Ontario Drug Benefit program (ODD)

Answer 22

the ‘formulary’ = list of prescription drugs that the province has identified they’ll pay for eligible people (~5,000 in Ontario)

○ >65
○ <25 and not covered by a private insurance plan (through parents .etc)
○ Living in a long-term care home/special care home
○ Receiving professional home and community care services
○ Receiving benefits from Ontario Works or Ontario Disability Support Program
○ Enrolled in the Trillium Drug Program
- for people who spend approximately 4% or more of their after-tax household income on prescription drug costs

Question 23

T or F: Health Canada sets drug pricing

Answer 23

F:
○ body that regulates drugs, approving health and safety from pharmaceutical companies

○ Approve safety and effectiveness

○ No association with price

Question 24

Common drug review (created by CADTH)

Answer 24

○ Evaluates clinical effectiveness, cost effectiveness .etc making recommendations to provinces if it is a good idea (ex. Ontario Ministry of Health)

○ 90% of cases just listen to CADTH

○ 51% of common drug review recommendations have been to not list a drug in formulary due to cost effectiveness

Question 25

T or F: Drug companies speak to province/territory to negotiate prices individually

Answer 25

T

Question 26

process of drug review

Answer 26

health canada = common drug review = ontario ministry of health = ODB program

Question 27

Patented Medicine Prices Review Board

Answer 27

= an independent tribunal that limits the prices set by patentees for all patented medicines sold in Canada to ensure they’re not excessive

○ Review drug prices from pharmaceutical companies and evaluates reasonability for drugs

Question 28

T or F: Patented Medicine Prices Review Board reviews drug prices from pharmaceutical companies only for patented drugs

Answer 28

T:
○ Only for patented drugs

*Patent only for 20 years, other companies can rebrand and sell for cheaper

Question 29

T or F: Patented Medicine Prices Review Board can review the prices negotiated with the federal, provincial, or territorial drug plans, advising them

Answer 29

F:
- Does not regulate the prices of generics
- has no jurisdiction to review the prices negotiated with the federal, provincial, or territorial drug plans

Question 30

Patented Medicine Prices Review Board evaluates:

Answer 30

*Prices of other drugs from the same therapeutic class in the market

*Prices of the same medicine and other medicines in the same therapeutic class in comparator countries
(France, Germany, Italy, Sweden, Switzerland, UK, USA)
○ Changes in the Consumer Price Index
**exception: breakthrough drugs can be 3000% more

Question 31

~under 20x the Patented Medicine Prices Review Board has told companies prices were excessive in Canada and they need to reduce the price - impacts of this?

Answer 31

• Impact of telling them to reduce price = they might not use it in Canada = 40 million people not using product

*Financial incentive to create deal

Question 32

Overarching recommendation

Answer 32

= country introduced national pharmacare

*List principles = same as Canada Health Act (CUP AP)

Question 33

Liberal government said they want to do what regarding pharmacare in their re-election campaign

Answer 33

= implement Pharmacare

*Liberal government is a minority government, harder to pass laws
*Partnered with NDP, liberals need to commit
*Claim passing of pharmacare by end of 2023 … if not agreement will dissolve