QC thaws drug price freeze. End of pharmacare?

Hikes capped to inflation. Some seniors, the poor to get free meds

By Peter Woodford

Provincial drug plan policy makers from across the country are keeping a close watch on developments in Quebec. Last month Quebec Health Minister Philippe Couillard announced an end to the price freeze for patented prescription drugs that had been in effect since 1994.

The new policy comes into effect in July 2008, and any price increases will be capped at inflation. The government's plan also includes an awareness campaign aimed at discouraging doctors from writing unnecessary scripts. It's earned plaudits from industry, mixed reviews from social justice activists, plus a few accusations of political opportunism (a provincial election was called just days later).

Minister Couillard emphasized that the plan would help about 250,000 welfare recipients and 29,000 of the province's poorest seniors; they're currently subject to often-onerous co-pays. This delivers on a nearly forgotten election promise from Premier Jean Charest's successful 2003 campaign. In the middle of another election, his Liberals are in dire need of a bit of good news about the province's beleaguered health system.

As for the drug price thaw, Minister Couillard said the status quo was no longer sustainable. "It was keeping us isolated from economic reality," he told the Montreal Gazette. "Also, we were facing a situation where some manufacturers would withdraw their products from the Quebec market. We were going to lose access to certain medications."

Was he just being alarmist? Claudine Laurier, PhD, of the University of Montreal's pharmacy school, doesn't think so. "I tend to agree with Dr Couillard in this case," she says.

Brett Skinner, the Director of Health and Pharmaceutical Policy Research at the Fraser Institute, thinks the thaw was long overdue. "Economic reality is a hard teacher. When governments attempt to free ride on pharmaceutical development, it is patients who pay the price in lack of access," he wrote.

But others aren't convinced the sky was falling. "Perhaps they were getting close — but I don't think there's a lot of evidence that drug companies were holding back marketing in Quebec," says Bryan Ferguson, a healthcare consultant at Applied Management and an expert on Canadian drug policy. "In fact, Quebec has always had a pretty open policy — approving drugs quickly — so the freeze was quite an acceptable price to pay for the drugmakers." He notes that drug approvals were starting to slow down and things were definitely veering in a direction that wouldn't be to the companies' liking. "When access starts to tighten, it's harder to keep the lid on prices — there's no question that eventually there's a limit."

PHARMACARE CROWN
So how do these changes leave Quebec's pharmacare coverage compared to the rest of the country? "I think the Quebec model is the most effective," opines Mr Ferguson. "It's a blend of low out-of-pocket expenses, wide selection of approved drugs and a mix of private and public systems.

"Ontario's public plan [Trillium] is a pretty good deal for some seniors. The costs are lower for individuals but while it does well at making things affordable it doesn't do so well at getting the right drugs to people," he adds, alluding to the public plan's strict standards for listing medications. He says the Western provinces' public drug plans also tend to over-emphasize user low costs at the expense of drug selection.

The cash-starved Atlantic provinces remain the worst off, offering their citizens the least protection against catastrophic drug costs. "You have situations where people die in hospitals rather than at home simply because they can't afford drugs," says Mr Ferguson, adding that the provinces that already have catastrophic drug insurance (namely BC, Saskatchewan, Manitoba and Ontario) tend to set the 'catastrophe' bar fairly high.

Mr Ferguson isn't optimistic we'll get a national pharmacare plan anytime soon. "The National Pharmacare Strategy [which came out of the 2005 Council of the Federation summit] is still there and there are some people pushing a national plan similar to hospital insurance, but what we're probably more likely to see is a national catastrophic drug insurance system — no one should have to go bankrupt paying for medications." He notes that such a system would cost the feds anywhere from under $1-4 billion annually.

SONGS OF LOVE & HATE
Rx&D, the group that represents Canada's pharma industry, likes the new plan. Philip Blake, the group's chairman and Bayer's boss, says pharma innovations have saved the system enormous amounts of money by reducing hospitalization rates for illnesses like asthma, ulcers and diabetes.

But Montreal-based coalition Physicians for Social Justice feels the plan is too generous to drugmakers. "The pharmaceutical companies are making money hands over fists," Dr Paul Saba, a physician at the Lachine Hospital and the group's co-president, told the CBC."They're the most profitable industry, and they don't need any more special favours."