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Health

National pharmacare – might it be a pig in a poke?

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11 minute read

From the Macdonald Laurier Institute

By Nigel Rawson and John Adams for Inside Policy

No Canadian should have to choose between paying for medicines and paying for rent or food. National pharmacare has been proposed as a remedy to this situation.

“When will Canada have national pharmacare?” asks the author of a recent article in the British Medical Journal (BMJ). Better questions are: will Canadian pharmacare be the system many Canadians hope for? Or, might it turn out to be skimpy coverage akin to minimum wage laws?

In its 2024 budget document, the federal government proposed providing $1.5 billion over five years to support the launch of national pharmacare for “universal, single-payer coverage for a number of contraception and diabetes medications.” This has been hailed as a “big day for pharmacare” by some labour unions, patients and others, including the author of the BMJ article who said that national pharmacare should be expanded to cover all medication needs beginning with the most commonly-prescribed, clinically-important “essential medicines.”

In its budget, the government stated “coverage of contraceptives will mean that nine million women in Canada will have better access to contraception” and “improving access to diabetes medications will help improve the health of 3.7 million Canadians with diabetes.” Why not salute such affable, motherhood and apple pie, sentiments? The devil is in the details.

The plan does not cover new drugs for diabetes, such as Ozempic, Rybelsus, Wegovy, Mounjaro or Zepbound, all based on innovative GLP-1 agonists, where evidence is building for cardiovascular and weight loss benefits. This limited rollout seems based on cheap, older medicines, which can be less effective for some with diabetes.

The federal government has also consistently under-estimated the cost of national proposals such as pharmacare – not to mention other promises. In their 2019 election platform, the Liberals promised $6 billion for national pharmacare (the NDP promised $10 billion). Keen analysis shows that even these expansive amounts would be woefully inadequate to fund a full national pharmacare plan. This makes the $300 million a year actually proposed by the Liberals’ look like the skimpy window-dressing that it is.

National pharmacare, based on the most comprehensive existing public drug plan (Quebec’s), would cost much more. In 2017, using optimistic assumptions, the Parliamentary Budget Officer (PBO) estimated the cost for a national plan based on Quebec’s experience to be $19.3 billion a year. With more appropriate assumptions, the Canadian Health Policy Institute estimated $26.2 billion. In June 2019, the federal government’s own Advisory Council on the Implementation of National Pharmacare put the cost at $40 billion, while a few months later, the tax consulting company RSM Canada projected $48.3 to $52.5 billion per year. Five years later, costs no doubt have soared.

Even with these staggering cost a program based on matching Quebec’s drug plan at the national level would fail to provide anywhere near the level of coverage already provided to the almost two-thirds of Canadians who have private drug insurance, including many in unionized jobs. Are they willing to sacrifice their superior coverage, especially of innovative brand-name medicines, for a program covering only “essential medicines”? Put another way, are Canadians and their unions prepared to settle for the equivalent of a minimum wage or minimum benefits?

The PBO has estimated the cost of coverage of a range of contraceptives and diabetes medicines as $1.9 billion over five years, which is more than the $1.5 billion provided in the budget. However, this figure is based on an assumption that the new program would only cover Canadians who currently do not have public or private drug plan insurance, those who currently do not fill their prescriptions due to cost related reasons, and the out-of-pocket part of prescription costs for Canadians who have public or private drug plan coverage. This is major guesswork because existing public and private drug plans may see the new federal program as an opportunity to reduce their costs by requiring their beneficiaries to use the new program. If this occurs, the national pharmacare costs to the federal government, even for the limited role out of diabetes and contraceptives, would soar to an estimated $5.7 billion, according to the PBO.

Our governments are not known for accurate estimates of the costs of new programs. One has only to remember the Phoenix pay system and the ArriveCAN costs. In 2017, the Government of Ontario estimated $465 million per year to extend drug coverage to every resident under the age of 25 years. What happened? Introduced in 2018, prescriptions rose by 290% and drug expenditure increased to $839 million – almost double the guesstimate. In 2019, the provincial government back peddled and modified the program to cover only people not already insured by a private plan.

Although we believe governments should facilitate access to necessary medicines for Canadians who cannot afford their medicines, this does not require national pharmacare and a growing bureaucracy. Exempting lower-income Canadians from copayments and premiums required by provincial programs, as British Columbia has done, and removing the requirement to pay for all drugs up to a deductible would allow these Canadians access sooner, more simply, and more effectively.

Moreover, it isn’t just lower-income Canadians who want help with unmet medicine needs. Canadians who need access to drugs for diseases that are difficult to treat and can cost hundreds of thousands of dollars per year also require assistance. Few Canadians whether they have low, medium or high incomes can afford these prices without government or private insurance. Private insurers often refuse to cover these drugs.

The Liberals provided a separate $1.5 billion over three years for drugs for rare disorders, but no province or territory has signed a bilateral agreement with the federal government for these drugs and no patient has received benefit through this program. Even if they did, the $500 million per year would not go far towards the actual costs. There is at least a zero missing in the federal contribution, as the projected cost of public spending on rare disease medicines by 2025 is more than threefold what Ottawa has budgeted.

Expensive drugs for cancer and rare disorders are just as essential as basic medicines for cardiovascular diseases, diabetes, birth control, and many other common conditions. If a costly medicine will allow a person with a life-shortening disease to live longer or one with a disorder that will be severely disabling left untreated to have an improved quality of life and be a productive taxpayer, it too should be regarded as essential.

The Liberals and NDP are working to stampede the bill to introduce the pharmacare program (Bill C-64) through the legislative process. This includes inviting witnesses over the first long weekend of summer, when many Canadians are away, to appear before the parliamentary Standing Committee on Health three days later.

Too much is unknown about what will be covered (will newer drugs be covered or only older, cheaper medicines?), who will be eligible for coverage (all appropriate Canadians regardless of existing coverage or only those with no present coverage?), and what the real cost will be, including whether a new program focusing on older, cheaper drugs will deter drug developers from launching novel medicines for unmet needs in Canada.

This Bill as it stands is such a power grab that, if passed, the federal Health Minister never has to come back to Parliament for review, oversight or another tranche of legal authority, it would empower the Cabinet to make rules and regulations without parliamentary scrutiny.

A lot is at stake for Canadians, especially for patients and their doctors. Prescription medicines are of critical importance to treating many diseases. National pharmacare must not only allow low-income residents to access purported “essential medicines” but also ensure that patients who need specialized drugs, especially higher-cost innovative cell and genetic therapies that may be the only effective treatment for their disorder, are not ignored. Canadians should be careful what they wish for. They may receive less than they anticipate, and, in fact, many Canadians may be worse off despite the increase in public spending. Time to look under the hood and kick the tires.

Nigel Rawson is a senior fellow with the Macdonald-Laurier Institute.

John Adams is co-founder and CEO of Canadian PKU and Allied Disorders Inc., a senior fellow with the Macdonald-Laurier Institute and volunteer board chair of Best Medicines Coalition.

COVID-19

Trump’s new NIH head fires top Fauci allies and COVID shot promoters, including Fauci’s wife

Published on

From LifeSiteNews

By Doug Mainwaring

“During the pandemic Fauci’s bioethicist wife, Christine Grady, offered nurses a choice: Get vaccinated, or lose your job,” noted The COVID-19 History Project on X. “Yesterday, she was offered a choice: Transfer to an office in Alaska, or lose your job. What’s fair is fair. Everyone deserves a choice,” explained the COVID watchdog account.

On day one of his new job as head of the National Institutes of Health (NIH), Dr. Jay Bhattacharya removed four powerful agency heads, including Dr. Anthony Fauci’s wife, Christine Grady, and others associated with the questionable handling of the COVID-19 shots.

Grady, who had served as chief of the agency’s Department of Bioethics, and other longtime Fauci allies in top posts at the NIH involved in the development and distribution of the untested COVID shots produced by Big Pharma were offered jobs in Alaska and other remote locales far away from the NIH’s sprawling Bethesda, Maryland, complex just outside Washington, D.C.

The purge came amid massive layoffs in health-related agencies under the umbrella of Health and Human Services (HHS), now headed by the Make America Healthy Again (MAHA) movement’s founder, Robert F. Kennedy Jr., who has long questioned vaccine safety and American medicine’s focus on treating disease rather than preventing it.

A total of about 20,000 personnel – mostly bureaucrats – or about 25 percent of the HHS workforce have been or will be handed pink slips amid Kennedy’s realignment of the agency.

MAHA critics were quick to call Tuesday’s axing of Fauci confederates as “one of the darkest days in modern scientific history” fueled by Kennedy’s desire to exact revenge on Fauci’s former trusted associates who represent the antithesis of the MAHA movement.

However, the revamping of the federal government’s side of the health industry is no more harsh than the treatment meted out by those formerly in control who, at best, suppressed, and worst, punished those who questioned their iron grip on health-industry regulations and standards.

For years, Kennedy’s critics have dismissed his quest to revamp healthcare and his questioning of the efficacy of the COVID-19 mRNA jabs as anti-science, labeling him as an “anti-vaxxer” in order to suppress his messaging.

Dr. Francis Collins – whom Bhattacharya replaced as head of NIH – in an October 2020 email to Fauci condemned Bhattacharya as a “fringe epidemiologist” because he had co-authored the Great Barrington Declaration, which criticized harmful COVID lockdown policies.

“During the pandemic Fauci’s bioethicist wife, Christine Grady, offered nurses a choice: Get vaccinated, or lose your job,” noted The COVID-19 History Project on X.

“Yesterday, she was offered a choice: Transfer to an office in Alaska, or lose your job. What’s fair is fair. Everyone deserves a choice,” explained the COVID watchdog account.

“We spend 4X more than Italy on healthcare — and live 7 years less. Dead last in cancer rates. This isn’t science — it’s a system profiting off sick kids,” explained Calley Means, RFK Jr. HHS advisor during an interview with Laura Ingraham following the NIH firings.

“Firing the people who oversaw this? That’s step one,” declared Means.

Other NIH officials who were offered reassignments were Dr. Jeanne Marrazzo, who succeeded Fauci as head of the National Institute of Allergy and Infectious Diseases (NIAID), Dr. Clifford Lane, a close Fauci ally who served as deputy director for clinical research at NIAID, and Dr. Emily Erbelding, NIAID’s microbiology and infectious diseases director.

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Courageous Discourse

Europe Had 127,350 Cases of Measles in 2024

Published on

By Peter A. McCullough, MD, MPH

US Mainstream Media Maintains Myopic Focus on Less than 1000 Cases

As the measles story in the US continues to unfold with reporting of a few cases here and there come in through mainstream media, I wondered about measles in Europe.

The WHO casually reported that the Europe Region had 127,350 cases in 2024.

According to an analysis by WHO and the United Nations Children’s Fund (UNICEF), 127 350 measles cases were reported in the European Region for 2024, double the number of cases reported for 2023 and the highest number since 1997.

Children under 5 accounted for more than 40% of reported cases in the Region – comprising 53 countries in Europe and central Asia. More than half of the reported cases required hospitalization. A total of 38 deaths have been reported, based on preliminary data received as of 6 March 2025.

Measles cases in the Region have generally been declining since 1997, when some 216 000 were reported, reaching a low of 4440 cases in 2016. However, a resurgence was seen in 2018 and 2019 – with 89 000 and 106 000 cases reported for the 2 years respectively. Following a backsliding in immunization coverage during the COVID-19 pandemic, cases rose significantly again in 2023 and 2024. Vaccination rates in many countries are yet to return to pre-pandemic levels, increasing the risk of outbreaks.

Many regions in Europe have lower rates of measles vaccination than the goal of 95%.

 

Less than 80% of eligible children in Bosnia and Herzegovina, Montenegro, North Macedonia and Romania were vaccinated with MCV1 in 2023 – far below the 95% coverage rate required to retain herd immunity. In both Bosnia and Herzegovina and Montenegro the coverage rate for MCV1 has remained below 70% and 50% respectively for the past 5 or more years. Romania reported the highest number of cases in the Region for 2024, with 30 692 cases, followed by Kazakhstan with 28 147 cases.

The WHO Report does not mention adjudication of hospitalizations or deaths. Presumably hospitalization of healthy kids is routine for contagion control. So if measles is so common and presumably well-handled by Europe, why is it such a big deal in the United States? Don’t look for Sanjay Gupta or Anderson Cooper to tell you that a similar size region and population handles >100K cases per year without much fanfare.

Peter A. McCullough, MD, MPH

President, McCullough Foundation

www.mcculloughfnd.org

 

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