Recent changes have come from the Ministry of Health to the existing Pharmacare plan. One of the significant drivers of escalating health care costs in the past decade has been the growth of the Pharmacare budget. While the reasons are many, the reality is that the Pharmacare budget has increased 147% in the last 10 years, an unsustainable expansion. Attempts to deal with the rising cost of pharmaceuticals have been the focus of many reforms over the last decade.
Many of the reforms have come forward with little or no input from practising physicians, or have been foisted upon the profession without consultation. Some of these initiatives I have found acceptable, such as generic substitution. Others have been quite unacceptable. Both reference-based pricing and special authority forms have been problematic, resulted in poor medication choices for patients, or wasted my time in bureaucratic quagmire.
In 2001 the BCMA had the opportunity to make a presentation to the Ministry of Health as part of their review of Pharmacare financing. In its submission, the BCMA recommended the following:
• A balanced approach to Pharmacare financing is needed to ensure its sustainability.
• Pharmacare must ensure that BC residents are not denied access to prescription medication due to an inability to pay, therefore the program must cover all prescription costs beyond a defined out-of-pocket maximum.
• Pharmacare benefits should be income-tested for all age groups and should be applied equally across all disease circumstances.
• Protecting low-income earners is essential, as financial barriers can actually lead to increased overall costs. There should be no out-of-pocket costs for very low income individuals.
• The rules and policies of the Pharmacare program must be simplified and the true costs of prescription drugs should be made more apparent to recipients.
Tough decisions have to be made. How much money should be spent on Pharmacare, relative to all other sectors within the total health care expenditure? How are funding priorities determined? How does public money get distributed so that it is fair? Pharmacare can’t be everything to everyone—so what are the principles around which this program operates?
The recent change to Pharmacare to bring in a means test is one that I consider fair. Limiting benefits based on income is an equitable way of distributing public funds. Providing some medications for all people with extraordinary chronic diseases—such as cystic fibrosis, HIV/AIDS, persistent serious mental illness—is also one that I can support.
Let me go out on a limb and suggest other reforms for Pharmacare to consider. What about a competitive bidding process for eligible medical supplies? Imagine what would happen to the price of the test strips for glucometers if companies had to compete to be the “preferred providers.”
I also find the benefits for the methadone program troubling at times. I am all for harm reduction and support a methadone program to deal with narcotic addiction. All too often in my practice as a hospitalist I deal with individuals who are abusing multiple substances (some of which are prescription) and also using methadone. One such individual had a 1-inch thick Pharmacare search for the year 2002. Where are the checks and balances in the system to ensure that methadone use is under legitimate circumstances and not just another substance to be consumed?
Any money that can be saved should be spent on funding childhood vaccines that are not currently provided by public health, such as Varivax. Funding vaccines would ensure that children in lower-income families had the same opportunity to benefit from these new agents. And that’s a good thing.
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