Author
Brett J Skinner, Ph.D.
Introduction
On February 27, 2018, the federal government established an Advisory Council on the Implementation of National Pharmacare. Pharmacare is proposed as a national, universal-coverage, publicly-funded, government-run, single-payer monopoly that would entirely replace Canada’s current pluralistic system of federal-provincial-territorial publicly-funded government-run drug plans, and employment-based private drug plans. One of the main reasons cited to justify a national pharmacare program is a claim (based on a misinterpretation of widely publicized surveys about prescription cost-related non-adherence) that millions of Canadians are not covered by any type of drug plan.
Objective
To examine prescription drug plan coverage across Canada to determine how many people were insured, under-insured or uninsured.
Data
The most recent data (2015-16 FY end March 31) for utilization, and related eligibility and cost-sharing criteria were obtained directly from the federal, provincial and territorial public drug benefit programs, health ministries or other government departments/agencies. Corresponding private drug plan data were obtained from the Canadian Life and Health Insurance Association. Population and income data were obtained from Statistics Canada.
Results
In 2016 the total population of Canada was nearly 36.3 million. The number of people covered by a private drug plan was almost 23.2 million. The number of active claimants in provincial and territorial public drug plans (1st payer or 2nd payer coverage) was almost 8.2 million and the number of people eligible for NIHB coverage was almost 840,000. Nearly 4.1 million people remained eligible for either 1st payer or 2nd payer coverage under public drug plans.
Conclusions
In 2016 Canada had near universal insurance coverage across the population for ordinary prescription drug costs and universal coverage for high drug costs. Lower income families that do not have a private drug plan are covered by some type public drug plan with no or low deductibles, copayments and/or premiums. Middle to higher income families that do not have a private drug plan are exposed to progressive income-adjusted deductibles, copayments and/or premiums before qualifying for full public drug benefits.
