Five things to know about Ontario’s new youth pharmacare program

Theglobeandmail.com
April 28, 2017
By Kelly Grant

From doctors to pharmacists to drug makers, nearly everyone in the Canadian health-care world is lauding the Ontario government for its plan to provide free prescription drugs to children and youth, beginning Jan.1.

“I think it’s really positive,” said Joshua Tepper, a family doctor and the chief executive officer of Health Quality Ontario, an agency that advises the province on improving the health-care system. “I have absolutely seen patients, including kids, whose health gets worse because they can’t afford their medications.”

If there is any complaint among front-line providers, it is that the Liberal program does not go far enough toward providing universal access to prescription drugs for everyone. Premier Kathleen Wynne said Friday that she hopes Ontario’s move will prod the federal government and other provinces to work together on a national pharmacare strategy, but that is a call the Trudeau government has so far declined to answer.

Here are five things to know about Ontario’s new youth pharmacare program, and how it could play into a national prescription drug strategy.

1. It’s a big symbolic gesture

For a select age group, Ontario’s plan would confer on prescription drugs the same status as medical care provided at the doctor’s office or in the hospital – just flash your health card, and it’s free. This is a first in Canada, a country where public drug coverage is usually available only to the poor and the old, and often requires co-pays and deductibles. “This is medicare-like,” said Steve Morgan, a drug-policy expert and a professor at the School of Population and Public Health at the University of British Columbia. “Canada’s medicare system is a universal, public, first-dollar, single-payer system. What Ontario has done is say, ‘We’re moving in that direction with pharmacare, starting with the population group that is most affordable for government to add this coverage to.”

2. Of all age groups, youth are cheapest to cover

The Ontario government estimates it will cost $465-million a year to cover prescriptions for four million people under the age of 25. The province already pays for prescription medications for about 600,000 people in that age group, more than 370,000 of them social assistance recipients, the rest children and youth with catastrophic annual drug bills. Outside those two categories, children and youth take relatively few prescription drugs on average. “The incremental [cost] expansion here is not dramatic,” Dr. Morgan said. Still, Colin Busby, the associate director of research at the C.D. Howe Institute, said the Ontario government needs to explain how it can afford the new program. “If your plan is to expand public coverage or take on a large share of existing private costs there has to be measures in place to pay for those,” he said. “I keep thinking, ‘Who’s going to end up paying for these programs?’”

3. The program could yield savings for businesses, but it’s unclear how much.

The Canadian Life and Health Insurance Association couldn’t put a number on the savings yet. “There will be some degree of savings for employers going forward. How employers use those savings will vary by employer,” said Stephen Frank, a senior vice-president at the organization. Ontario’s Health Minister Eric Hoskins wants all savings to insurance plans passed on to employers and employees. Jordan Brennan, an economist for the union Unifor, said that employers will be expected to either reduce drug deductibles or offer employees new services. “This will free up space to do other things at the bargaining table aside from trying to bring down benefit coverage,” Mr. Brennan said.

3. About one-quarter of Ontarians have no prescription drug coverage

In its most recent annual report, Health Quality Ontario cited survey results that showed about one-quarter of Ontarians between the ages of 12 and 64 do not have insurance for prescription medications, a figure that has held steady since 2008. Recent immigrants, people who did not graduate from high school, and people living in poor neighbourhoods were likeliest to lack insurance. “Kids obviously aren’t going out and buying their own coverage,” Dr. Tepper said. “So when we see that recent immigrants to Canada have dramatically less coverage for prescription medications, that means the children of immigrants have much less coverage.”

5. The Trudeau government is cool to national pharmacare

Some provincial governments - especially the Ontario Liberals - have been clamouring for national pharmacare for years, while reports making the same case have been gathering dust since as far back as the 1960s. Rather than expand medicare to cover all prescription drugs, Federal Health Minister Jane Philpott has said she would concentrate first on reducing prices and improving access in other ways.