Download Pharmaceutical Policy in Canada: Reflections on a Shifting Landscape Steve Morgan, PhD

Pharmaceutical Policy in Canada:
Reflections on a Shifting Landscape
Steve Morgan, PhD
Centre for Health Services and Policy Research
University of British Columbia
THE
COMMONWEALTH
FUND
Centre for
HEALTH SERVICES AND POLICY RESEARCH
Canadian “Medicare”


Centre for
HEALTH SERVICES AND POLICY RESEARCH

Canadian Pharmacare
Centre for
HEALTH SERVICES AND POLICY RESEARCH
The coverage landscape:
Under- and Un-insured for Routine Drug Costs
50%
40%
30%
20%
10%
Uninsured
Centre for
HEALTH SERVICES AND POLICY RESEARCH
N
F
PE
N
S
N
B
Q
C
O
N
M
B
SK
A
B
B
C
C
A
N
0%
Under Insured
Source: Applied Management (2000) "Canadians’ Access
to Insurance for Prescription Medicines Volume 2”
The coverage landscape:
Under- and Un-insured for Catastrophic Costs
50%
40%
30%
20%
10%
Uninsured
Centre for
HEALTH SERVICES AND POLICY RESEARCH
N
F
PE
N
S
N
B
Q
C
O
N
M
B
SK
A
B
B
C
C
A
N
0%
Under Insured
Source: Applied Management (2000) "Canadians’ Access
to Insurance for Prescription Medicines Volume 2”
The financial landscape
1.2%
Drug Spending as % of GDP
1.0%
0.8%
0.6%
0.4%
0.2%
0.0%
1933
1943
1953
1963
1973
Medical & Pharmaceutical Products
Centre for
HEALTH SERVICES AND POLICY RESEARCH
1983
1993
Retail Rx
Source: CIHI and Statistics Canada
The result, a national pastime…
Provincial Inquiries
– New Brunswick
– Saskatchewan
– British Columbia
National Inquiries
– Romanow
– Kirby
– National Forum on Health
– House of Commons
Centre for
HEALTH SERVICES AND POLICY RESEARCH
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
Centre for
HEALTH SERVICES AND POLICY RESEARCH
What are policy makers seeing?
Centre for
HEALTH SERVICES AND POLICY RESEARCH
The Shifting Landscape?
Centre for
HEALTH SERVICES AND POLICY RESEARCH
The financial landscape
1.2%
Drug Spending as % of GDP
1.0%
0.8%
0.6%
0.4%
0.2%
0.0%
1933
1943
1953
1963
1973
Medical & Pharmaceutical Products
Centre for
HEALTH SERVICES AND POLICY RESEARCH
1983
1993
Retail Rx
Source: CIHI and Statistics Canada
The demographic landscape
Centre for
HEALTH SERVICES AND POLICY RESEARCH
Source: Statistics Canada
What are policy makers doing?
Centre for
HEALTH SERVICES AND POLICY RESEARCH
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)
Centre for
HEALTH SERVICES AND POLICY RESEARCH
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”
Centre for
HEALTH SERVICES AND POLICY RESEARCH
Thank you
Centre for
HEALTH SERVICES AND POLICY RESEARCH