Canadian HR Reporter

CANADIAN HR REPORTER AUGUST 2019 8 NEWS private in place as it is, you don't get those savings." e advisory council explored a variety of pharmacare models over a 12-month period, and each pointed to a single-payer conclu- sion, according to Hoskins. e council travelled to each province and territory to hold in-person discussions through roundtables, and it also met with Indigenous governments and rep- resentative organizations. Through consultations with 32,000 Canadians, members came to realize a shared belief that all citizens should have access to prescription drugs, based on need — not their ability to pay, he says. The June recommendation marks the completion of the council's mandate. Universal pharmacare is now expected to go before the people by way of the federal election process this fall. "e only way we're going to fix a system which is near the break- ing point… is to transform it," says Hoskins. "e time has come, and hope- fully there's sufficient political will. Canadians have indicated that they want it, and we think that this is the best model to achieve it." 'Significant savings' If implemented, a universal phar- macare framework's improved negotiating power and lower ad- ministrative costs could save Ca- nadians $5 billion per year, says Hoskins. In addition, employers provid- ing drug coverage to staff could save hundreds of dollars per em- ployee while earning relief from the costs of prescription drug in- surance, he says. "We estimate that employers, on average, will save $750 per employee, per year, which is a sig- nificant savings." The council recommended that employers able to purchase supplementary private drug in- surance for workers continue to do so, even as the nature of pri- vate insurance participation will change. Savings expected through a single-payer plan would give em- ployers an opportunity to rein- vest in the company, staff salaries and various health benefits, says Hoskins. Employees are also being asked to contribute more to benefits plans in terms of premium con- tributions, co-payments, deduct- ibles and increased annual limits. "Cost-related non-adherence is actually a significant problem and a growing problem," he says. At present, Canada trails only the United States and Switzer- land in terms of prescription drug spending, says Hoskins. But savings isn't the only driver of the recommended pharmacare overhaul. It's also about unifor- mity, equity and fairness, he says. One in five Canadians is cur- rently uninsured or underinsured when it comes to prescribed med- icines, says Hoskins. "Absent a single-payer model, it's difficult — if not impossible — to achieve that important goal of fairness and equity and unifor- mity and consistency across the country." Lower insurance costs Canadian employers should get behind the national pharmacare plan, as it would solve many chal- lenges around access to prescrip- tion drugs, says Doris Grinspun, CEO of the Registered Nurses' Association of Ontario. "When you have national pharmacare, you also get bet- ter drug pricing on prescription medicines," she says. "ere are so many different angles that one can look at from an employer's perspective." Lower insurance costs would put Canadian employers in a bet- ter position, compared to interna- tional competition at a time when a shortage of labour is a growing concern, says Grinspun. "ey should get behind the plan — and the sooner, the bet- ter — because then they also have more influence power and they can work collectively [to] help influence and push for the issue of bulk purchasing… and proper prescribing." From workers' health to finan- cial outcomes, universal pharma- care would aid all aspects of the workplace, she says. "It's not just for employers or employees. It's for everybody... I have no fears, I only see benefits." Pharmacare funding e proposed pharmacare plan would be phased in over an eight- year period, beginning with a for- mulary covering essential medi- cines, according to Hoskins. "Part of the reason why we phased it was because it's enor- mously complex," he says. "It re- quires a lot of negotiations — not only with provinces and territo- ries but also with drug manufac- turers, in terms of lowering the prices… But it also gives signifi- cant runway to both employers and insurance providers to adjust to a new approach." If implemented, the plan would be funded through general reve- nue streams, says Hoskins. "ere are many examples in the past where significant national investments — new investments — have been made without it re- sulting in an added or new cost to Canadians," he says. "We're offering a model that will reduce [prescription drug] costs… and we're recommending that it be funded as we do health care generally." Forty-seven per cent of small and medium-sized employers support a single-payer pharma- care framework, while 27 per cent are opposed, according to a 2019 Canadian Federation of Indepen- dent Business (CFIB) survey of 2,837 business owners. "We really don't want to see the burden placed on the shoulders of small and medium-sized business owners, because already the costs associated with drug coverage is a concern," says Emilie Hayes, senior policy analyst at CFIB in Ottawa. "e smaller the business, the more expensive and the harder it is for them to even have the option to provide it to their employees." In theory, the opportunity to negotiate lower drug prices and provide universal care is sup- ported by employers; cost issues remain the main source of con- cern, she says. "What we really don't want to see is the funding basically in the form of a payroll tax or increased GST," says Hayes. The single-payer framework will level the playing field for workers with no employer-funded benefits, says Hoskins. "e idea that if you're working you are covered is a bit of a myth," he says. "Because if you're pre- carious or contract or part-time or working for a small business or self-employed, chances are you're not going to have coverage. "We did look at that very care- fully and explicitly to make sure that what we were proposing would address that as well." No 'free ride' for employers But employers expecting a free ride are in for a rude awakening, says Brett Skinner, CEO of the Canadian Health Policy Institute in Toronto. "Employers who think they can offload their costs on to the public sector and not pay anything for it are dreaming in Technicolor... e tax bill is going to flow back at them somehow." e current system — while pluralistic — is adequate, says Skinner. e gap occurs when Ca- nadians are required to purchase drugs that are unlisted on their formulary. "The single-payer model of pharmacare — all it does is shift costs from the private sector to the public sector and from the provinces to the federal level. It does nothing to close the actual gap that people face," he says. "ere's 23 million Canadians who are privately insured who are going to have to accept inferior benefits under a universal plan." The council's recommenda- tion was "totally predictable," says Skinner. "e fix was in. ey certainly did not genuinely consider con- trary advice or give a fair shake to any other alternative option, like filling the gaps in the current system." Employers in 'for rude awakening,' says expert PHARMACARE < pg. 1 With a single-payer plan, Canadians would receive prescribed medications through a single entity. Credit: Kimberly Boyles (shutterstock)

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