Provincial plans' significance lost in pharmacare talk, says Fraser Institute

by Leo Almazora17 Oct 2018

The intensifying discussion of a possible national pharmacare plan continues to stir strong reactions from stakeholders, including patient advocates, life and health insurers, brand-name manufacturers, and the generics industry. While most agree on the need for national universal coverage, some are calling for a rational implementation that considers what the existing system already provides.

Add a new analysis from the Fraser Institute to that list. The report warns that “unqualified claims regarding Canada’s approach towards drug coverage” has led to a perception that Canadian governments do not currently help Canadians pay for their prescription medications.

“Lacking in the debate [on national pharmacare] is a clear understanding of the coverage that is already available to those subsets of the Canadian population who may be at higher risk of foregoing their prescriptions due to cost,” the paper said. It also asserted that disregarding the central issue of access for vulnerable populations could lead to a bias for “solutions that may use scarce health care dollars to subsidize the majority of Canadians who likely don’t need help.”

In its analysis of provincial drug plans across Canada, the institute saw extensive coverage for lower-income Canadians, thought it found it some provincial programs were “notably more generous” than others based on several criteria.

The review compared plans based on the “most generous” level of coverage they provided, based on lowest premiums, deductibles, and/or copayments by families and individuals for the same (or higher) level of drug coverage. Focusing on families of four, the highest income level eligible for the most generous level of public drug coverage varied from $15,000 in British Columbia to nearly $40,000 in Alberta. For single individuals, the highest income level qualified for the most generous level of coverage ranged from $10,000 in Nova Scotia to nearly $21,000 in Alberta.

“Most provinces have considerably higher income limits for access to the most generous level of provincial coverage for families in comparison with limits for individuals,” the report noted.

As for coverage available for seniors, the institute found that it was more generous for lower-income individuals; the income limits for the most generous coverage ranged from “caps based on federal income supports to $33,000 for British Columbians born before 1939.” And while income thresholds for accessing public coverage differed across provinces, seniors tend to have much more generous coverage than single non-seniors assuming limits have been satisfied.

The study also looked at the extent of coverage provided for a given level of income for each province. Using the highest income values for Statistics Canada’s Low Income Cut-Off (LICO) for families and individuals, it found that most provinces offered coverage for families and individuals with incomes who fall within the LICO cut-off, subject to either a premium or deductible.

“[W]hile the income levels at which coverage applies do vary, lower-income Canadians have access to at least some form of provincial insurance for prescription drugs that helps limit out-of-pocket costs to a small percentage of income, if not more extensive coverage, in every province across Canada,” the report said.

 

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