A call for a universal drug plan for Canada
It's been 70 years since a report called for medicine to be covered by national health insurance. After many campaign promises, why doesn't Canada have universal pharmacare?
But critics argue that the pharmaceutical industry is able to charge exorbitant rates because they have too much influence on government.
“We have some of the highest drug prices in the world – and we have the lowest public funding for prescription medicines within the (Organization for Economic and Co-operation and Development, OECD),” said Colleen Fuller, co-founder of PharmaWatch, an national advocacy group on medicines. “We have the highest generic drug prices, the second-highest brand name prices, and one of the lowest levels of public funding.
“These are huge problems,” she added. “The lack of public involvement both in funding and monitoring drugs means that, not only are people exposed to a much higher risk when they use prescription medicines, but they're paying a much higher price than they should be paying.
“The industry has huge tentacles in government both nationally and provincial... What they want is more drugs on the market, they want them approved quickly, they want to be able to charge the highest price that they possibly can, and the government should just butt out. All they care about is money, and that is the bottom line.”
What Fuller and some other activists would like to see is not simply a universal pharmacare plan – but for Canada to get back into the business of researching and manufacturing cheaper medications.
She cites the example of the publicly-owned Connaught Laboratories, which was created at the University of Toronto in 1914 to fight an outbreak of diptheria – a disease known as “the strangler” and the leading cause of death among children. The labs went on to become the world's first insulin producer, but in 1984, Brian Mulroney's Conservative government privatized Connaught and today they have been merged into the pharmaceutical giant Sanofi-Aventis.
“Now, we don't make a drop of insulin in Canada, even though it was discovered here,” Fuller said. “All of the insulin in Canada is provided by foreign corporations – our own legacy being totally betrayed by the federal government.
“We have to put that to the Conservatives, because they're the ones who caused that to happen. It's a disaster – we're paying some of the highest prices for these kinds of vaccines, as a consequence of these public policies. We need a public manufacturer in Canada that's accountable, that works in the public interest, and is not charging an arm and a leg for medicines that we need.”
Fuller worries that Canada's ongoing negotiations for a free trade agreement with Europe – the Comprehensive Economic and Trade Agreement (CETA) – will fuel a race to the bottom for drug standards and prices, already underway through Conservatives' attempts to reform Canadian drug regulations. She said that pharmaceutical companies have gained a seat at the government table – while citizens advocacy groups are sidelined.
“It's all being done behind closed doors, and industry is actually sitting down with them to figure out how to change the regulations,” she said. “Who's sitting with Canada at the table? It's the drug industry, the asbestos industry – there are no citizens at the table at all, in discussions.
“So they have a huge influence over the decisions being made at the trade table, as well as at the domestic policy table.”
Maude Barlow, national chairperson of the Council of Canadians, told the Vancouver Observer that CETA poses a major threat to Canada's already weak drug price regulations – allowing companies to extend their patents for years longer, and thereby delay the creation of cheaper generic versions.
“The immediate issue around CETA is we have to agree to align our pharmaceutical patents to the European ones – which are much more in favour of the transnational drug companies – and their patent regime,” Barlow said. “That would increase our drug prices by about $3 billion a year.
“CETA applies to not just the federal government but provincial and municipal governments. That immediately offsets any kind of cost-cutting you might want to do for health care.”
Dr. Law agreed that pharmaceutical companies exert a major influence on drug prices and government regulations – but believes that Canada does, in fact, play an important role in regulating prices.
“There's a lot of inertia when you have a system involving $30 billion, and involving a lot of companies and manufacturers that make a lot of money,” he said. “The people who can't afford their medication, unfortunately, don't have a vocal lobby group.
“There's people not taking their drugs for a whole range of cost reasons. They tend to be the poor, the sick and the uninsured. They're not a powerful political lobby group.”
Currently, Law said, one of the governments' main strategies for lowering prices includes negotiating with manufacturers to cut their rates – in exchange for adding their drugs to lists of insurable medications.
Law made a distinction, however, between costs to the medical system and governments, and how much consumers actually pay for drugs over-the-counter. The latter costs are driven up by wildly varying pharmacy dispensing fees – which range from $4 to $14, he said – and differences in people's health insurance coverage.