Canada should tiptoe in the direction of national pharmacare by creating a new drug agency and a master list of prescription medications that would be available to all, regardless of ability to pay, according to a federal advisory council.

But the Liberal-appointed panel’s interim report, obtained by The Globe and Mail, is silent on the big question of whether Canada should adopt a universal, single-payer pharmacare plan or simply plug the gaps in the existing system to ensure that all patients can afford to fill their prescriptions.

Eric Hoskins, a former Ontario health minister who leads the council, said in an interview that the panel would recommend a specific model for pharmacare in a final report to be released before the end of June, four months ahead of an election scheduled for October.

In the meantime, the main suggestions in the council’s slim interim offering – it’s only eight pages long – could be starting points for any type of national pharmacare plan, he said.

“Nothing has been ruled in or ruled out,” Dr. Hoskins said. He added that the “recommendations are foundational and can apply to any model.”

Finance Minister Bill Morneau and Health Minister Ginette Petitpas Taylor are scheduled to unveil the interim report at a news conference in Toronto Wednesday – the same day Prime Minister Justin Trudeau’s former principal secretary, Gerald Butts, is expected to testify in Ottawa about his role in the SNC-Lavalin controversy engulfing the government.

The Liberals’ political future looked much better a year ago when the government announced the creation of an Advisory Council on the Implementation of National Pharmacare in its most recent budget.

The plan was to have the council draw up a blueprint for pharmacare that the Liberals could then make a key plank in their bid for re-election in October.

But with the government now reeling from the resignations of senior cabinet members Jody Wilson-Raybould and Jane Philpott over the SNC-Lavalin affair, it’s difficult to predict how much oxygen a pharmacare proposal would get on the campaign trail, even if the NDP runs on expanding public drug coverage as expected.

Dr. Hoskins said he was still confident the political stars would align in national pharmacare’s favour, despite that goal having eluded the country for decades.

The seven-member advisory council found that, after conducting cross-country consultations, reading more than 150 written submissions and poring over 15,000 answers to an online questionnaire, almost nobody supported Canada’s patchwork of public and private drug plans. The report said the system “is neither adequate nor sustainable over the long-term and leaves too many Canadians behind.”

Canada also spends more per capita on drugs than almost any other country, while leaving as many as 20 per cent of Canadians either uninsured or under-insured, according to the report.

As well, the report points out that an onslaught of new, high-priced drugs is straining the financial stability of both public and private drug plans. Total prescription-drug spending in Canada grew to $34-billion in 2018, up from $2.6-billion in 1985, with about one-third of today’s spending going to 2-per-cent of beneficiaries.

“Without reform the system will soon be at the breaking point,” the report says.

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The council’s interim report says any pharmacare plan should adhere to a list of core principles that include a guarantee all Canadian residents get the prescription drugs they need without financial barriers to access and a guarantee drug coverage be consistent, no matter where patients live.

The program would also require a “robust pharmaceutical management system that promotes safety, innovation, value-for-money and the sustainability of prescription drug costs.”

To that end, the council recommends that Canada create a national drug agency, develop a comprehensive, evidence-based national formulary – or list of covered drugs – and invest in drug data and information technology systems.

The national drug agency would manage the national formulary. It would also likely bring under one roof the functions of two existing agencies that advise governments on whether to cover new drugs, and activities of the pan-Canadian pharmaceutical alliance, the office that negotiates group drug discounts on behalf of the provinces, territories and Ottawa.

Separately last year, a Liberal-dominated parliamentary committee released an exhaustive report calling for a national, single-payer pharmacare program that would do for prescription drugs what Medicare did for health care offered in hospitals and doctors’ offices.

The Globe and Mail, March 5, 2019