Phamacare round table presentation

1. Former Government Proposed
Models

2. 2003 First Ministers Health Accord
National Pharmaceuticals Strategy (NPS)
F/P/T commitment that :
“No one will be denied access to necessary, very
high-cost drugs based on where they live , or
their ability to pay.”

3. Principles for NPS
1. Universality: all Canadians are eligible
2. Equity : comparable coverage across the country
3. Transparency : coverage levels are easy to understand and
access
4. Integrated : catastrophic protection is integrated with
other public and private drug plans
5. Sustainability : affordable, sustainable, and balanced with
other health care priorities

4. Two Options for Design Proposed
1. Option one :Threshold for the program :
variable percentage of family income from
0%, 3%,6% and 9% after which drugs covered
100%. Below $20,000 income =0% and above
$90,000 = 9%.
2. Option two : 5% fixed income threshold after
which drugs are covered 100%

5. OUTCOME of NPS Proposal
After protracted negotiations among F/P/T
partners:
RIP

6. Kirby and Romanow Reports, 2002,
Commission Recommendations
• Both supported catastrophic drug plans
• Both identified maximum $1500 per annum
threshold for
catastrophic drug transfer to federal plan
> Kirby added 3% of household income to a
maximum of $1500 per year as threshold for a pan-
Canadian catastrophic drug plan

7. OUTCOME Of Report
Recommendations
• After tabling and discussion
RIP

8. Ontario Minister of Health’s Expert
Roundtable June, 2015
Group of academics, provincial government bureaucrats
and politicians, consultants
Issues raised:
 Increasing costs and prices of brand, generic drugs
 Poor prescribing practices
 HTA recommendations
 Limited drug budgets both publicly and privately
 Limited R+D from industry
 Aging population
 Rare diseases and novel drug innovations

9. Main Solution
Pharmacare as defined by a common national
list of drugs covered by all jurisdictions

10. Federal Minister of Health’s Mandate
Exploring the need for a national formulary

11. F/P/T Ministers of Health Meeting
January 2016
Announcement of an F/P/T Working Group to
study pharmacare

12. Model Proposed by Canadian
Treatment Action Council (CTAC), 2009
Universal Catastrophic Drug Plan
 Legislated addition to existing public plans
 Multi- stakeholder funded insurance plan
 Available to all Canadian residents i.e. universal, needs
based
 For prescription drugs, biologics, medical devices, approved
by HC
 Rare diseases included
 Cosmetic treatments excluded
 Prescribed by a regulated HC professional
 No waiting period from province to province
 For those without any or adequate coverage

13. CTAC Model
Coverage and Funding
 First dollar coverage after cost sharing
 Sliding scale cost sharing based on family income and
tax bracket
 $0 cost for those in lowest tax bracket
 $ TBD for each higher tax bracket
 No increased cost to anyone as a result of plan
introduction from last year’s out of pocket expenses
 F/P/T governments and employers will also contribute

14. CTAC Model
Listing Decisions
 Drug listing based on best clinical evidence and
practice, not only on cost
 All prescribers required to sign an Appropriate
Prescribing and Utilization Commitment document
 Pharmaceutical manufacturers to fund objective
prescriber education on appropriate prescribing and
utilization, adherence
 Manufacturers will contribute to systematic, regular
revision of Canadian databases and textbooks

15. CTAC Model
Plan management
Managed centrally and administered by
existing F/P/T drug plans
Central management body evaluates every
three years
Tabled to MoHs and made public
No substantive changes made to the plan
without public consultation

16. CTAC Model
Private Plans
Stay in place
Remain first payers
Public plans are second payers as presently
Catastrophic plan kicks in third

17. CTAC Model
Costs
This depends on what you measure as
cost/benefits
Rare disease inclusion makes no real
difference
Initial econometric modelling determined that
this would not cost more than present system
but this needs updating to 2016 realities