What happened to Catastrophic and Rare Disease Drug Coverage?

The increased importance of pharmaceutical drugs in Canadian health care was not foreseen during the drafting of the Canada Health Act, federal legislation that sets out the requirements that provincial jurisdictions must satisfy in order to qualify for federal funding of their health care system. As a result, prescription drugs are covered in certain circumstances, such as during a visit to the hospital, but this coverage ends once you are discharged.

The 2003 Romanow report on health care proposed a series of initiatives with the ultimate goal of incorporating pharmaceutical drugs into the Canada Health Act. In October of 2004, the First Ministers created the Ministerial Task Force to guide the creation of the national pharmaceutical strategy, focusing on 9 key areas.

The Ministerial Task Force released an update in 2006, that was criticized for a lack of measurable progress, and also for the fact that of the 9 issues that the Task Force was to address, 4 did not make their way into the report.

Two areas of importance to Canadians are catastrophic drug coverage and coverage for expensive drugs for rare diseases. We have done our best to ferret out the progress made in these two areas.

What happened to Catastrophic Drug Coverage?

The idea behind catastrophic drug coverage is that Canadians should never be overwhelmed by the cost of drugs. It isn’t only Canadians with illnesses such as HIV or cancer that need help with high costs, someone with chronic health conditions could also have difficulty making ends meet.

In 2006, the National Pharmaceuticals Strategy ministerial task force reported that progress on catastrophic drug coverage consisted of considering ways to determine nationwide criteria for Canadians to qualify.

In September 2008, the provincial and territorial ministers of health issued a public statement that catastrophic drug coverage is as essential to Canadians as physicians and hospital coverage and that the federal government has a funding responsibility to establish a minimum standard of drug coverage for all Canadians.

Most of the provinces have developed some sort of program to assist those individuals whose drugs costs have reached a cost that is disproportionately high to their income. Most provinces have a system in place to address this issue, such as a deductible, sometimes income tested, which prevents drug costs from getting too high. As of November 2008, PEI and New Brunswick did not have a catastrophic drug program. PEI has since implemented a high cost drug program to assist individuals and families with the costs of certain high cost drugs. New Brunswick still lacks a program for catastrophic drugs, with the exception of those individuals diagnosed with HIV/AIDS, and in May of this year the plight of a Fredericton man struggling with both cancer and drug bills made the news.

Politically, catastrophic drug coverage was a minor election issue in the 2008 federal election.

What happened to Coverage for Expensive Drugs for Rare Diseases?

Governments identified the need for a collaborative approach to this issue, given the extremely high cost of these therapies, that if one jurisdiction were to decide to fund them, other jurisdictions would be pressured to follow suit and the possibility of Canadians moving to jurisdictions where the medication is provided.