Colleen Fuller - Pharmacare in Canada Today

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  • 1. Pharmacare Goes to the Bargaining Table PharmaCare 2020 February 26, 2013
  • 2. Two important players on the drug scenePatient Advocacy Groups Disease specific, campaign-oriented, fundraisers Strong focus on public benefits, eg., PharmacareUnions In BC, approximately 36% of employees are covered by supplementary health benefits Majority of these are union members Unions are overlooked as key players
  • 3. Shifting SandsTwo events that had a dramatic impact on bargainingtables Wage controls , 1975-78 Capped wage increases for 4.2 million workers at 10%; 8% and 6% Established Programs Financing, 1977 New law downloaded costs of medicare from federal to provincial governments Eroded federal leadership in health policy
  • 4. Bargaining BenefitsSince 2000, employers have exercised 3 mainoptions to counter rising premiums: Downloading (higher premiums & deductibles) Eliminating benefit plans (retirees hit hardest) Cost-shifting: flexible benefits, health savings accounts
  • 5. InnovationsSeveral national unions and their employers havepioneered new strategies to protect employeebenefits In 2005, CAW and auto industry adopt Conditional Formulary: brand name drugs only funded with Special Authority by physician In 2004-2006, CUPW and Canada Post initiate two pilot projects: Health Canada funds use of herbal products to treat stress Alternative Therapies for chronic back pain, stress
  • 6. Union MembersUnion members get information from broadarray of sources, including patient advocacygroups Often Pharma-funded and sponsored (CPGs, education) Strong lobby for coverage of new drugs/devicesMediaPhysicians
  • 7. Bargaining ClimateEmployers reducing or holding the line on insurancepremiums for health, drug and other benefitsWage increases stagnant for last decadeUnionised workers are hitting a brick wall on wagesand worried about push to reduce benefits, increaseco-pays and deductiblesEmployers (including government) negotiatingPharmacare formulary
  • 8. Going up: Drug costs & premiums; Wages: not so much18.0016.0014.00 Drug Costs12.0010.00 Health Insurance 8.00 Premiums 6.00 Avg Annual Wage 4.00 Increases 2.00 CPI 0.00 2011 2000 2001 2004 2009 2010 2005 2002 2006 2003 2007 2008
  • 9. Cost Escalation2011 Projected to 2019 (Mercer 2011)
  • 10. New Realities: Who’s Insured Non- Full- Part- UnderYear All Male Female Union Union time time 25 % % % % % % % %1995 63.3 68.6 47.6 84.3 49.2 NA NA 34.61999 52.9 58.9 47.3 67.4 47.7 595 19.8 23.82001 51.8 57.1 46.7 66.2 46.3 58.1 18.5 26.02005 51.3 56.2 46.7 61.6 47.5 57.2 19.3 21.7
  • 11. Who Is Insured, 2011 Province Percentage Newfoundland 63.60Prince Edward Island 40.50 Nova Scotia 35.00 New Brunswick 30.70 Quebec 63.00 Ontario 63.60 Manitoba 48.40 Saskatchewan 56.40 Alberta 45.80 British Columbia 36.10 CANADA 50.60
  • 12. Against this backdropPublic sector employers in BCproposing Pharmacare formularyMany rank and file members see it as aconcessionSome unions supportive, others not Main theme is uncertainty
  • 13. Defending certain principles…Doctor-Patient RelationshipNew is betterChoice
  • 14. 1. Doctor-Patient RelationshipBoth patient advocacy groups and unions believe thechoice of drug is a matter between the doctor andpatientPublic, including union members, believe thatemployers, unions and governments should notinterfere with drug decisionsFew people understand what influences drugprescribing – or what should influence prescribing
  • 15. 2. New vs OldPatient groups influence attitudes - want government tofund new drugs and devicesUnions want employer benefit plans to fund new drugsand devices“Safe and effective” are two words strongly associated inthe minds of most people with the newest (and mostexpensive) drugs“Old” is associated with less safe and effective drugs“Old” is pushed by Pharmacare and employers becausethey are cheap
  • 16. The importance of consumer choiceThe more drugs that are covered the morechoices patients haveSafety and effectiveness are more importantthan costHowever, the real problem is not lack ofchoice, but lack of informed choice
  • 17. What Pharmacare should doPublic education Pharma is doing it, but governments aren’tSupport informed choice Respect the ability of consumers to make the right decision when they have the informationFund advocacy There is very little independent patient advocacy and the main reason is lack of funding
  • 18. What unions should doFind out what’s in the drug plan Negotiate access to formulary, including cost and utilization dataEducate members about evidenced-basedformularies Evidence-based approach commonly conceived of as an approach to strengthening public drug benefits, but it may work in private plans, too Members will support “evidence-based” managed formularies if they see a benefit for their families
  • 19. National PharmacareStrong support among Canadian unionsand their members Campaigns, educationStrong support among provinces But no vigorous advocacyNeed to mobilise public!
  • 20. Thank-you! Colleen Fuller PharmaWatch CanadaWorking for Consumer Rights and Safe Medicines http://pharmawatchcanada.wordpress.com