Councillor Q&A: In search of a National Pharmaceutical Strategy
Dr. Alex Gillis brings a truly international perspective to the Health Council of Canada. His training included four years at the Mayo Clinic in Rochester, Minnesota and two years at Childrenís Memorial Hospital in Chicago. He served as the chief of surgery at the IWK Health Centre in Nova Scotia from 1965 to 1994 and was instrumental in developing a pediatric surgical service in the Maritimes. Gillis also worked as chief of medical services for the Saudi Arabian National Guard in Riyadh and Jeddah. He returned to the IWK in the role of vice president of professional and academic affairs, and has served as interim president and CEO in 2002 and 2004.
Gillis sits on the Health Councilís steering committee that is shaping a pharmaceutical symposium slated for next year, and he has a keen interest in monitoring the jurisdictionsí progress in fulfilling their commitment to develop a National Pharmaceutical Strategy.
The 2003 Accord and 2004 Ten-Year Plan to Strengthen Health Care committed provincial, federal and territorial governments to ensure reasonable access to catastrophic drug coverage by the end of 2006 and to collaborate on promoting optimal drug use, best practices in prescribing and better cost management. The First Ministers agreed to establish a ministerial task force to develop and implement a National Pharmaceutical Strategy and to report on progress by June 30, 2006. In October of 2005 the First Ministers narrowed the focus of the NPS-in-development to five key goals: providing cost options for catastrophic pharmaceutical coverage; establishing a National Drug Formulary; accelerating access to breakthrough drugs; strengthening evaluation of drug safety and effectiveness and; pursuing purchasing strategies to obtain best prices for Canadians for drugs and vaccines.
The Task Force report was delivered to federal, provincial and territorial Health Ministers in early July and it was then presented to the premiers in late July at the Council of the Federation meeting in St. Johnís. Following that meeting, the Premiers directed the Health Ministers to release a report on NPS "by September."
As of this writing, a report has not been made public. The Health Council of Canada will continue to monitor developments in this area and will report on the strategy after the NPS report is made public. In the meantime, we asked Gillis to tell us about why he believes a National Pharmaceutical Strategy matters.
1. A National Pharmaceutical Strategy was a key component of the health accords. Why is it so important that Canada have one in place?
The health of Canadians is influenced significantly by their ability to obtain appropriate drugs at the right time and at an affordable cost. This is an important national issue that embraces health, quality of life and equity issues. There are problems in this country with pharmaceutical access and appropriateness which require solutions that are national and not limited to jurisdictions.
2. Pharmaceuticals are playing an increasingly important role in the health of Canadians, but it is also one of the fastest-rising costs within the health care system. From your perspective, does that make a more compelling case for or against an NPS?
Costs for drugs continue to increase annually in excess of inflation and exceed the costs of physiciansí services in Canada. A national strategy is truly a compelling need if Canadians are to have access to optimal pharmaceutical support as a component of their overall health care. Costs should not be an overriding concern, however. Equally we must evaluate effectiveness and safety. Prescribing practices are of pivotal importance (the Health Council of Canada will sponsor a national symposium on prescribing practices in 2007 to contribute to this issue). And letís not forget, there is a cost to denying people access to drugs. There is a human cost, because people may suffer needlessly. There is a financial cost, because patients who donít have access to drug therapies may ultimately receive more costly acute treatment as an illness progresses. And then there is the cost to system sustainability.
3. As a doctor working in Atlantic Canada, you must see examples of how the imbalance in access to pharmaceuticals impacts on patients and how they could stand to benefit from an NPS.
The imbalance is most obvious here. The vast majority of Canadians have some third-party coverage for drug costs, usually through their employer. But approximately two percent have none, and virtually all of them (about 600,000 people) live in Atlantic Canada! Obviously these Canadians are most in need of meaningful relief. This kind of imbalance increases the likelihood of people failing to receive necessary drugs simply because of cost.
4. With Canadian health care being largely the domain of the provinces, how can we provide a more level playing field for Canadians in terms of access to drugs? What role could the federal government play?
The federal government was a signatory and a funder of the Accord of 2003 and the Ten Year Plan of 2004. National strategies that deal with pharmaceuticals are likely to be costly, and the provinces and territories will expect the federal government to be a funding partner in this as well. But there is a template for cooperation here. The federal, provincial and territorial governments have collaborated in recent years on a number of national initiatives such as a National Prescription Drug Utilization Information System (NPDUIS), the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS), and initiatives to conduct systemic reviews of drug effectiveness and costs. So there are precedents for joint action. And there is demonstrated need for joint action, too. Iím looking forward to seeing a report from the Ministerial Task Force soon that provides some of the direction, details and dedication to action that this issue demands.