Can a minimum list of drug coverage for Canadians help reduce system costs?
A formulary could be a big part of the formula for drug coverage success in Canada.
Canada is currently a hodgepodge of different drug benefit systems with certain provinces covering certain drugs with differing costs.
The CLHIA is advocating a standardized approach to drug coverage starting with a formulary. “We think there should be a minimum list of drugs that everyone has access to, whether you’re in a different province or whether you’ve got public or private coverage,” said Stephen Frank, Vice President Policy Development and Health. “We think everyone should have a baseline but there should be room for differentiation over and above that.”
This is a view echoed by one the industry’s leading companies. Great-West Life supports the CLHIA’s vision of a national formulary “that would ensure a baseline of coverage for all Canadians and reduce some of the existing complexity in the system,” said Loretta Kulchycki, Vice-President, Group Marketing at Great-West Life.
“This would offer consistency across jurisdictions and coverage, and help reduce costs associated with complexity in the system,” she said. “Such a formulary would need to include drugs that treat chronic and rare diseases, so that provinces, plan sponsors or individuals who want additional coverage can have it.”
The other familiar issue associated with drug coverage in Canada is pricing. “Pricing aspects are also quite problematic,” said Frank. “Prices vary across the province. They vary by employer. We really do need to tackle that and get to a more standardized pricing level for everybody.”
The CLHIA believes the solution lies in collaboration between the industry and government.
“The provinces have started to collaborate on negotiating for drug pricing,” Frank said. “The challenge is they have not extended that pricing to employer plans and individuals.”
For example, if a person is covered provincially then they get a certain price that’s been negotiated but if they’re not covered they have to pay a different price. “That’s one area that we think needs to be addressed,” he said. “We think the provinces should be negotiating on behalf of all and sharing those prices with everyone. We’ve been urging for that to happen for several years now and continue to argue that’s the right way to go.”
Canada is currently a hodgepodge of different drug benefit systems with certain provinces covering certain drugs with differing costs.
The CLHIA is advocating a standardized approach to drug coverage starting with a formulary. “We think there should be a minimum list of drugs that everyone has access to, whether you’re in a different province or whether you’ve got public or private coverage,” said Stephen Frank, Vice President Policy Development and Health. “We think everyone should have a baseline but there should be room for differentiation over and above that.”
This is a view echoed by one the industry’s leading companies. Great-West Life supports the CLHIA’s vision of a national formulary “that would ensure a baseline of coverage for all Canadians and reduce some of the existing complexity in the system,” said Loretta Kulchycki, Vice-President, Group Marketing at Great-West Life.
“This would offer consistency across jurisdictions and coverage, and help reduce costs associated with complexity in the system,” she said. “Such a formulary would need to include drugs that treat chronic and rare diseases, so that provinces, plan sponsors or individuals who want additional coverage can have it.”
The other familiar issue associated with drug coverage in Canada is pricing. “Pricing aspects are also quite problematic,” said Frank. “Prices vary across the province. They vary by employer. We really do need to tackle that and get to a more standardized pricing level for everybody.”
The CLHIA believes the solution lies in collaboration between the industry and government.
“The provinces have started to collaborate on negotiating for drug pricing,” Frank said. “The challenge is they have not extended that pricing to employer plans and individuals.”
For example, if a person is covered provincially then they get a certain price that’s been negotiated but if they’re not covered they have to pay a different price. “That’s one area that we think needs to be addressed,” he said. “We think the provinces should be negotiating on behalf of all and sharing those prices with everyone. We’ve been urging for that to happen for several years now and continue to argue that’s the right way to go.”
