Op-ed: Provinces must take steps to cut drug costs
By Adrian Dix and Mike Farnworth
Last week, at the conclusion of interprovincial health-care discussions in Halifax, Canada's premiers and territorial leaders announced their plan to jointly purchase some generic drugs.
A worthwhile initiative, but it is just one step of several required to support public health care by reducing the rising cost of prescription drugs, and getting full value for tax dollars.
And with Ottawa unilaterally cutting health-care transfers, provinces and territories must act now on these measures to improve patient outcomes and generate savings that can be redirected to support other parts of medicare.
Prescription drugs represent the second-leading health-care cost in Canada after hospitals. According to the Canadian Institute for Health Information, over the past 27 years, drug costs in Canada have risen an average of 8.6 per cent annually. Moreover, CIHI notes that the aging population is not primarily responsible for rising drug costs; instead, expenditures are more influenced by what drugs are prescribed and what price public and private drug plans (and individuals) pay for them.
In the past decade, drug costs increased more in this country than in the U.S., the U.K. and Australia, and our drug prices are 30 per cent higher than the Organization for Economic Co-operation and Development average.
A recent University of B.C. study published in the Canadian Medical Journal reports that one in 10 Canadians cannot afford to follow up with drug treatments.
The rate is even higher in B.C., with one in six patients experiencing difficulty complying with prescriptions because of cost.
The premiers should consider the measures New Zealand takes to secure some of the most competitive drug prices in the OECD. For example, treatments that provide equal and safe treatment at a lower price are given priority over more marketed and expensive alternatives. To increase the supply of generics and get the best price, the country offers drug manufacturers an opportunity to bid for timelimited exclusive contracts after patents expire.
Through such policies, New Zealand has cut its average annual growth in pharmaceuticals to 0.8 per cent per capita and expanded coverage. In comparison, B.C., with about the same population, pays 45 per cent more for statins and 79 per cent more for ACE inhibitors, medications for high cholesterol and high blood pressure.
Brand-name drugs are also on average less expensive by 20 per cent.
The premiers could also consider expanding independent research into the true value different prescription drugs deliver.
Time and time again, since its creation in 1994, the Therapeutics Initiative, UBC's independent drugevaluation research agency, has saved lives and reduced costs for Pharmacare by determining which drugs are safe and provide a net therapeutic benefit. Health policy analysts credit it for saving, on average, the nearly $1-billion dollar Pharmacare budget 14 per cent annually. Physicians credit it for saving lives.
For instance, in recent weeks, the U.S. Federal Drug Agency fined GlaxoSmithKline $3 billion in part for not disclosing information about the safety of Avandia. In B.C., the TI sounded the alarm more than six years ago that Avandia increases the risk for heart attacks among Type 2 diabetics. As a result, fewer B.C. patients were put in jeopardy.
The TI now serves as a model for other countries drug monitoring and research agencies. Expanding the TI, making it a national resource, could benefit patients and health systems across the country.
Academic detailing, which provides physicians with unbiased information about the effectiveness of various new drug treatments promoted by pharmaceutical industry representatives, is another similar reform premiers should pursue. B.C.'s academic detailing program, introduced over 20 years to help counteract the influence of marketing by drug companies, has been endorsed by the likes of the province's auditor general.
The Health Council of Canada is recommending academic detailing be expanded across the country to improve doctors' prescribing decisions.
Premiers must also exercise their full influence to ensure that Ottawa does not block our access to generic drugs under the trade deal (the Comprehensive Economic and Trade Agreement) it is negotiating with the European Union. Conceding to the EU's demands that favour brand-name drug companies will cost provincial and employer drug plans hundreds of millions of dollars at a time when the patents on some of the most prescribed medications are expiring. Savings our province and patients should finally start to realize will be wiped out.
Stopping the pharmaceutical provisions of CETA, pursuing best practices in prescribing, ensuring speedy and safe access to generic drugs, protecting consumers against the rising cost of brand-name drugs - all of these measures and more will be needed to protect public health care by ensuring resources can be freed up to invest in primary care, prevention of disease and home support.
While premiers face the burden of managing federal cuts to the Canada Health Transfer agreements, it is patients who risk facing the biggest price for this shortfall.
This op-ed originally appeared in the Times Colonist.