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“Private payers certainly see themselves as an integral part of Canadian health care systems,” said Joan Weir, vice-president of benefits at the Association of Life and Health Insurance Companies of Canada, during of the webinar. “Drug funding keeps Canadians out of hospital and helps them manage their disease well through monitoring of prescribers. We add value to the entire Canadian healthcare system.
Weir doesn’t believe the national pharmacare initiative will materialize in the next three years. However, she noted that the federal government has several peripheral initiatives in play that could eventually lead to a national plan.
Also speaking at the webinar, Joe Farago, Executive Director of Private Payers and Investments at Innovative Medicines Canada, urged employers to keep in mind that provinces are key stakeholders in any implementation of a national pharmacare strategy. Ontario and Quebec have already released statements saying they will not allow the federal government to encroach on their provincial drug reimbursement policies, he said. “It’s going to be a long time before we see any significant movement.”
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Although Prince Edward Island was the first province to raise its hand for additional funding, it was actually based on a fill model, Farago added, noting that the $35 million provided to Prince Edward Island to advance the implementation of universal pharmacare was a way for the province to fund its drug program, which was lagging behind other provinces.
The federal government’s announcement also included establishing an essential drugs list, Weir said, adding that key questions, such as eligibility and funding, for that formulary remain unanswered. Additionally, the federal alliance has included a bulk procurement initiative, which it plans to have in place by the end of 2025. Farago said nearly all drugs on the Essential Medicines List will likely already be on on the insurers’ private forms.
Questions also abound about the federal government’s proposed national dental plan, Weir said, particularly about whether it will be available primarily to the uninsured and not to Canadians with private coverage. But any successful national dental care plan also depends on provincial adoption, she said. She cautioned employers changing their plans to determine whether the public plan will provide the kind of no-wait list dental care that currently exists or that attracts and retains employees.
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And while the government’s announcement doesn’t include much about drug plans for rare diseases, work is going on behind the scenes in this area with the Canadian Medicines Agency, Weir noted. In 2020, private insurers paid $650 million in rare disease drugs to more than 15,000 Canadians, so private payer stakeholders are rightly wondering what a new model might look like under the new alliance, she said.
Weir assumed that either the public or private plan can pay a claim up to a certain threshold – say, $80,000. If the drug costs $120,000, then the remaining $40,000 could go to the drug agency for payment or could be shared in some way by participants in a risk pool, he said. she explains. “If there were three payers, the form and eligibility criteria would all be jointly determined by all three – public, private and Health Canada.”
Private health insurance plans have been one of Canada’s most underrated capabilities, said Cole Pinnow, president of Pfizer Canada, also speaking at the webinar. Canadians with a private plan have doubled access to treatment, he added, noting that these treatments are being made available much sooner than they would for someone solely on a public plan. “Having earlier access to innovative treatments has a huge impact on employers, workers and the economy.”
There are 26 million Canadians who have private drug insurance and it is incumbent on this group to highlight the value of private health benefits, Farago said.
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