LIFE BEFORE PHARMACARE Report on the Canadian Health Coalition’s Hearings into a Universal Public Drug Plan LIFE BEFORE PHARMACARE: Report on the Canadian Health Coalition’s Hearings into a Universal Public Drug Plan November 2008 isbn 978-1-897569-07-8 Please make a donation to the CCPA... Help us continue to offer our publications free online. The Canadian Centre for policy alternatives make most of our publications available free on our website. Making a donation or taking out a membership will help us continue to provide people with access to our ideas and research free of charge. You can make a donation or become a member on-line at www.policyalternatives. ca. Or you can contact the National office at 613-563-1341 for more information. Suggested donation for this publication: $10 or what you can afford. This report is available free of charge from the CCPA website at www.policyalternatives.ca. Printed copies may be ordered through the National Office for a $12 fee. 410 – 75 Albert Street, Ottawa, Ontario k1p 5e7 tel 613-563-1341 email [email protected] www.policyalternatives.ca 2841 Riverside Drive Ottawa, Ontario K1V 8X7 www.medicare.ca CONTENTS Summary: Life Before Pharmacare .............................................................................5 1 Canadians Speak Up About the Suffering Caused by Inaction on Pharmacare ......7 2 The Reasons for Inequity .....................................................................................9 3 Problems Caused by Excessive Drug Costs and the Patchwork Approach ...........11 4 Stories from Across Canada ...............................................................................13 The Low Income Trap ........................................................................................13 Chronically High Costs ......................................................................................14 Caught in Government Red Tape ......................................................................16 Ponying Up for a Work-based Plan ....................................................................17 Laid Off from the Drug Plan ..............................................................................18 Paying the Price for New and Expensive Drugs ..................................................19 The Cost of a Move to a Different Province .......................................................21 Drug Coverage in the Pre-Retirement Years .......................................................22 Young Adults Shut Out of Drug Coverage .........................................................23 Life-Sustaining Drugs Not Covered by Provincial Plans ......................................24 5 Drug Insurance in Québec .................................................................................26 6 Conclusion ........................................................................................................28 7 Recommendations ............................................................................................30 Notes .....................................................................................................................31 Participants in Pharmacare Hearings .......................................................................32 ACKNOWLEDGMEnts The Canadian Health Coalition thanks the many people and organizations who made these hearings possible, including the organizers, volunteers, resource people, moderators, presenters, and participants. Thanks also to the following organizations whose financial assistance made the hearings and this publication possible: • Canadian Auto Workers • CAW Retired Workers • Canadian Federation of Nurses Unions • Canadian Labour Congress • Canadian Union of Postal Workers • Canadian Union of Public Employees • Communications, Energy and Paperworkers Union of Canada • Congress of Union Retirees of Canada • Inter Pares • National Union of Public and General Employees • Public Service Alliance of Canada • United Steelworkers of America DEDICATION To those who shared their stories, their suffering, and their hopes for the future. To the memory of: • René Quigley, organizer of the Halifax hearing • Jim Connor, presenter at the Halifax hearing • Marion Dewar, chairperson of the Ottawa hearing 4 CANADIAN CENTRE FOR POLICY AltERNATIVES and CANADIAN HEALTH COALITION SUMMARY Life Before Pharmacare IN THE FALL OF 2007, the Canadian Health Coalition (CHC) began a series of groundbreaking hearings in communities across the country. It was the first time that public hearings had been organized to deal specifically with Canadians’ experiences and insights regarding the cost, effectiveness, appropriateness, and availability of prescription drugs. This report features the stories told by people who appeared at the hearings. For example, Gretta Ross of Sarnia, Ontario, who said: “The burden of a loved one being sick in front of you and going down with dementia, is enough. Last year we were $6,000 in debt with drug bills. Now we are faced with losing our home. We both worked hard all our lives and I don’t think that’s right.” Over 250 people made presentations at the hearings. Many spoke of their personal experiences with injuries, illnesses, and chronic conditions that require prescription drugs. Doctors, nurses, pharmacists, and social workers spoke about the difficulties faced by their patients and clients because prescription drugs are not within reach. The stories collected in this report will help explain to politicians, policy- makers and journalists why we urgently need a national drug plan and better management of pharmaceuticals in health care. Canadians tend to believe that everyone is taken care of when it comes to prescription drugs. We think that elderly people are covered by provincial drug plans; that people in need are covered by social assistance; and that working people get drug coverage through employer benefit plans. But the hearings, and much research in the field, show this is not the case. Many Canadians do not LIFE BEFORE PHARMACARE 5 have drug coverage of any kind, and those who do are facing exorbitant and ever-increasing costs. Medicare, our universal, public health care insurance plan, was introduced over 40 years ago. Since then, pharmaceuticals have fundamentally changed the nature of health care and yet they are still not included in Medicare. Instead, we have a patchwork of private and public plans that are full of holes, leaving many Canadians without comprehensive drug coverage. Some people can afford to pay for drug insurance or the drugs themselves, but others cannot. This situation is reminiscent of the days before Medicare, so this report is called “Life Before Pharmacare.” At the end of this report, there is a list of recommended actions needed to rectify this inequity. At the top of the list is a call for a universal public drug plan that would be cost-shared by federal and provincial governments and employers, and administered by provinces and territories. This is what many people at the hearings called for. In the words of Philip Lillies of Moncton, whose wife who suffers from multiple sclerosis: “Efficiency is one of the strongest arguments for implementing a comprehensive, universal pharmacare program. The hodge-podge of programs that attempt to substitute for it is not only unfair; they are also costly both in a financial sense and a social sense.” For information on the Canadian Health Coalition’s Pharmacare Campaign, visit www.healthcoalition.ca/pharmacare-now.html. 6 CANADIAN CENTRE FOR POLICY AltERNATIVES and CANADIAN HEALTH COALITION 1 Canadians Speak Up About the Suffering Caused by Inaction on Pharmacare IN THE FALL OF 2007, the Canadian Health Coalition (CHC) began a series of groundbreaking hearings in communities across Canada. It was the first time that public hearings had been organized to deal specifically with Canadians’ experiences and insights regarding the cost, effectiveness, appropriateness, and availability of prescription drugs. Hearings were open to everyone with an inter- est in a public drug insurance plan. The stories collected in this report will help explain to politicians, policy-makers and journalists why Canadians urgently need a national drug plan and better management of pharmaceuticals in health care. As the hearings moved from British Columbia to the Northwest Territories to Newfoundland, Canadians from all walks of life spoke about the impact on their lives of the rising cost of pharmaceuticals. Many wondered why drugs are covered by provincial health care plans if a person is hospitalized, but it’s pay- as-you-go as soon as a patient is discharged. Others asked if prescription drugs have become the answer for almost all medical ailments when in many cases other less expensive treatments would be more effective. Still others were frus- trated by a confusing patchwork of provincial drug plans that meant a person’s prescriptions were covered in one province but not in another. In total, over 250 people made presentations during the hearings. Many spoke of their personal experiences with injuries, illnesses, and chronic condi- tions that require prescription drugs. Doctors, nurses, pharmacists, and social workers spoke about the difficulties faced by their patients and clients because prescription drugs are not within reach. Some presenters spoke as representa- tives of organizations such as social planning councils, political parties, unions, and advocacy groups. LIFE BEFORE PHARMACARE 7 As the hearings stretched from October