Canadian HR Reporter - Ontario

CANADIAN HR REPORTER NOVEMBER 2018 12 NEWS "e benefits program isn't just about health insurance, it's partly about compensation." If there is an intent to have a private/public mix, then having prices that are negotiated at a level playing field for both public and private will enhance the abil- ity for those private plans to keep offering benefit coverage, said Schmidt. "And not just drug coverage but other benefits coverage — that's an integral part of the Canadian health-care system, really." e system has to be affordable both for taxpayers and business- es, she said, citing the challenges of rare diseases and high-cost drugs. "You can't just suddenly trans- fer all the costs to the private sec- tor. You can't suddenly transfer all of it to the public sector," said Schmidt. Lavoie agreed. "If there's an area of opportu- nity for a government interven- tion being first-payer, first-claim, first-dollar type, wherever you de- fine the threshold, then that can be defined in dollar, or maybe in volume of — or prevalence of — disease, or what have you." But in designing a national pharmacare program, it has to be forward-looking, said ériault. "is is the notion of sustain- ability, to me, that goes beyond the day-to-day fiscal and account- ing side of it… it's much deeper in terms of how we find a solution for that." "How do we redefine a fund- ing model that makes the whole environment around the pharma environment — from industry to delivery, for patients, for employ- ees — sustainable from that per- spective? I think that's a tougher conversation, and it's a system- design conversation. It's not only about the drug, or how we pay for it, it's how we deliver it, it's how we provide access to it… e value that's perceived, that will be differ- ent for different stakeholders." And we're not just talking about drugs, said ériault. "If you give someone that Hep C drug that saw a big spike in costs for employers a few years ago… then you're preventing possible hospital admission, or possible chronic care later. You can't just look at the drug piece, you have to look at the whole piece. And private plans play a big part in the Canadian health-care system, and the… government needs to sup- port the ability for those private plans to continue." When it comes to the ultra-high cost drugs, there almost needs to be a universal, first-payer system, said Schmidt. "(That means) everyone has access to the same list of drugs across the country, and that helps employers or private plan spon- sors have a robust system with a reduced level of risk, and then a second tier that is that financial protection against hardship for out-of-pocket costs that can be part of a private plan, or a public plan," she said. "So... it's not necessarily one pharmacare system. I think you have to look at different types of pharmacare based on the different types of needs." All pharmaceutical plans — whether they're single-payer, multi-payer, first-dollar coverage or catastrophic coverage — are facing the pressure from these niche drugs being required, said Alam. "And we're going to see the way patients are treated change over the next five years, over the next 10 years, so that treatment be- comes much more tailored to the individual patient." "It again comes back to… what kind of plan we want to create, what are our principles, what are we moving towards? And under- standing that that incremental approach — which seems to be favoured by Canada, because all of the provincial plans, disparate as they are, they're all incremen- tal approaches towards universal pharmacare… has to extend be- yond the election cycle." Redefining funding model PHARMACARE < pg. 10 Helen Stevenson, Reformulary Group With an increasing number of high-cost drugs coming to market, access and affordabil- ity are greater concerns than ever before. ese rising costs affect the underinsured and uninsured the most. About two per cent of Cana- dians have no coverage, while around 10 per cent cannot af- ford to pay the co-insurance or deductibles for their coverage. However, when considering the entire picture, we cannot ignore that the current system is working well for most. The Canadians who have access to public and/or private coverage enjoy affordable ac- cess to a broad range of pre- scription medicines, largely made possible by the private sector, which plays a criti- cal role and covers 25 million Canadians through workplace benefit plans. In the end, finding a model that works for all is what mat- ters the most. Sun Life recog- nizes that while the current system is working well, there are opportunities to enhance it, by addressing the following issues: Ensuring access and equity National pharmacare is a key federal government priority. For this reason, the Advisory Council on the Implementa- tion of National Pharmacare was established earlier this year to provide independent advice on the best way to im- plement a national pharma- care program. With over 100 public drug coverage programs in the country, it's difficult for most Canadians to navigate and understand if they're covered by one of them. With the im- plementation of a standard formulary through a private, workplace plan — or through a public plan for those without workplace coverage — we can help ensure all Canadians have access to the medication they need. Drug plan sustainability and equitable pricing Allowing private insurers to join the federal and provincial governments as part of the pan-Canadian Pharmaceuti- cal Alliance would achieve the same negotiating power and savings as a single payer plan, and ensure the lowest prescrip- tion costs for all. A common evidence-based decision-making process, such as the one undertaken by the Canadian Agency for Drugs and Technologies in Health, would help provide a transpar- ent standard and cost-effective treatment for all Canadians. High-cost, catastrophic drug coverage As costs for specialty drugs continue to rise as a propor- tion of overall drug spending, it is vital for any national phar- macare program to recognize the needs of Canadians who rely on these lifesaving medi- cines. If costs continue to rise as predicted, coverage for these drugs may simply become un- affordable for employers. By covering catastrophic drugs, the government can make an important difference in the lives of Canadians, and can help prevent related future costs (for example, govern- ment-funded hospital stays). Sun Life is taking an active role in paving the way towards a system that continues to build upon the strengths and assets of the public and pri- vate sectors — a system that is affordable, achievable and protects the workplace benefit plans that are highly valued and relied upon by millions of Canadians. To find out more on what we're proposing, read our Bright Paper at www.sunlife. ca/nationalpharmacare. A glimpse into the future of Canada's national pharmacare Nadia Alam, Ontario Medical Association Louis Thériault, Innovative Medicines Canada Jean-Michel Lavoie, Sun Life Jennifer Schmidt, Mercer Justin Bates, Neighbourhood Pharmacy Association of Canada Credit: John Hryniuk

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