The Nova Scotia Citizens Health Care Network

The Nova Scotia Citizens Health Care Network

Medicare.. Need NOT Greed!

We appreciate this opportunity to make a submission about prescription drugs to the House of Commons Standing Committee on Health as part of its study on this topic. The cost and access to prescription drugs have long been one of the most pressing issues for public health care. In our view, nothing can do more to enhance or undermine proper care and treatment than access to needed prescription drugs.

The Nova Scotia Citizens Health Care Network was established in 1996. It has truly become a provincial network involving seniors’, women’s, anti-poverty, persons with disabilities and community groups and labour. It is affiliated with the Canadian Health Coalition and provincial health coalitions across the country and is dedicated to protecting, strengthening and expanding Medicare.

We believe fundamentally in the basic right of all Canadians to health and to health care, and in health care being a public service for which we all a collective responsibility to make accessible and available to all Canadians regardless of their background, circumstances or geographic locations. As stated in the final report of the 1964 Royal Commission on Health Services, “… that as a nation, we now take the necessary legislative, organizational and financial decisions to make all the fruits of the health sciences available to all our residents without hindrance of any kind”.

The best way we think this basic right and collective responsibility can be exercised is through a publicly funded and operated health system that is consistent with the five basic principles of the Canada Health Act: universality, accessibility, comprehensiveness, portability and public administration. In our view, health and health care should never be viewed as commodities or services oriented primarily for profit and that operate according to so-called business principles.

As we identified in our initial letter of request to the Committee, we are especially concerned about the rising costs of prescription drugs, the review and control of prices, approval of new drugs, access to drugs and moving to a national pharmacare program. Nova Scotia does not have a universal prescription drug program. However, there are four prescription drug programs funded and operated by the Government of Nova Scotia: the Nova Scotia Seniors’ Pharamacare Program, the Community Services Pharmacare Program for clients who qualify under the Income Assistance Program and the Community Supports for Adults Program, Drug Assistance for Cancer Patients and Multiple Sclerosis Drug Funding Assistance.

While these programs are helpful and well-utilized, our members and others report a number of major concerns with access to and cost of prescription drugs:

� the constant de-listing of drugs from the Nova Scotia formulary at least over the last year or so such as painkillers, drugs for arthritis and eye drops

� the extensive delays and tie-ups for doctors in getting approval for drugs not listed on the Nova Scotia

� the increasing costs of premiums for employer or workplace health plans due to increasing prescription drug costs

� the demeaning and demoralizing process that people who are ill and not working have to go through in order to access needed drugs such as that for treatment of AIDS and HIV

� the increasing cost of over-the-counter drugs that patients are frequently urged to obtain by their physicians.

All in all, the provision of prescription drugs resembles very closely how hospital and medical private plans used to provide a patchwork of coverage in the days prior to the introduction of public hospital and medical care insurance. In fact, we see at least a three-tiered system in place with respect to the cost and access to prescription drugs:

� those who have access through means-testing or other criteria to a limited number of drugs

� those who have no coverage whatsoever and who are often forced to choose between paying for drugs and paying for other essentials such as food, heat, light or rent.

As noted by the Canadian Institute for Health Information in its 2003 report entitled Drugs Expenditure in Canada, 1985-2002, drugs both prescribed and non-prescribed continued to account for the second largest share of health spending after hospitals and surpassing that on physician services. And yet, as reported in the November 2002 Romanow Commission on the Future of Health Care in Canada, “However, there are significant disparities in coverage across Canada and these disparities could well become worse as provinces and territories face rising costs for prescription drugs” (page 195).

In the 2002 CIHI report, Nova Scotia had among the highest total drug expenditure per capita, the total prescribed drug expenditure per capita and the highest prescribed drug expenditure per capita but among the lowest public prescribed drug expenditure as a percentage of total prescribed drug expenditure. This table is enclosed at the end of our submission. Considering that Nova Scotia has among the lowest levels of health status on almost every common health indicator such as heart disease and cancer, inadequate access to prescription drugs is a serious problem and impediment to quick and effective treatment and recovery.

We believe that the time is long overdue for concerted federal, provincial and territorial action to deal with the costs and access to prescription drugs. As recommended in the 1997 National Forum on Health report in 1997, “Because pharmaceuticals are medically necessary and public financing is the only reasonable way to promote universal access and to control costs, we believe Canada should take the necessary steps to include drugs as part of its publicly funded health care system” (page 22, Volume I). They called for a carefully planned course leading to full public funding for medically necessary drugs (page 22, Volume 1).

� Ending or at least reducing the twenty-year patent protection that has existed for twelve years for brand-name drug products by multinational drug companies.

� Stopping the current pharmaceutical industry practice of “evergreening” in which brand-name drug manufacturers make variations to existing drugs in order to extend their patent protection.

� Fully implementing the six recommendations of the Romanow Report with respect to prescription drugs, especially those concerning a new Catastrophic Drug funding transfer, a new National Drug Agency to control costs and evaluate new and existing drugs, and establish a national formulary prescription drugs (page 189).

� Protect Canada’s health care system from possible challenges under international law and trade agreements as recommended by the Romanow Report (page 233).

� Move towards a comprehensive national drug program and even a national drug industry.

There are serious and worsening problems with cost and access to prescription drugs. This is completely unacceptable in light of an aging population and low rates of health status especially for Nova Scotia compared to the rest of Canada. The continued presence of at least a three-tiered system for access to prescription drugs must be ended.

The first major step is to address long overdue patent law problems such as the twenty-year patent protection for brand-name drugs and the practice of evergreening. These changes are essential if we wish to address escalating prescription drug costs and essential to any moves towards full public funding of prescription drugs. As stated by the National Forum on Health, “…increasing the share of public funding will hinge on the availability of fiscal resources. This reality should not distract from the central point: the issue is accessibility to needed services, combined with recognition that total costs may decrease if government costs increase. In fact, Canadians are already spending this money” (page 22, Volume I). Protections for public health care services must be sought in international trade deals. We cannot allow international developments to undo national initiatives on public health care.

At the same time, we believe there must be a longer-term commitment to establishing a national pharmacare program and a national drug industry. Only moving to a national level can we finally end the increasing inequities of the present patchwork of public and private prescription drug coverage. In our view, it is as essential to the future of Medicare as ending the creeping privatization and commercialization of public health care.

Table 1.	Drug Expenditure Summary, by Province/Territory and Canada, 2000

Source: Canadian Institute for Health Information, Drugs Expenditures in Canada, 1985-2002, April 2003