colleen fuller - pharmacare in canada today
TRANSCRIPT
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Pharmacare Goes to the Bargaining
TablePharmaCare 2020February 26, 2013
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Two important players on the
drug scenePatient Advocacy GroupsDisease specific, campaign-oriented, fundraisers
Strong focus on public benefits, eg., Pharmacare
UnionsIn BC, approximately 36% of employees are covered by supplementary health benefits
Majority of these are union members
Unions are overlooked as key players
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Shifting SandsTwo events that had a dramatic impact on bargaining tables
Wage controls , 1975-78Capped wage increases for 4.2 million workers at 10%; 8% and 6%
Established Programs Financing, 1977New law downloaded costs of medicare from federal to provincial governments
Eroded federal leadership in health policy
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Bargaining Benefits
Since 2000, employers have exercised 3 main options to counter rising premiums:
Downloading (higher premiums & deductibles)Eliminating benefit plans (retirees hit hardest)Cost-shifting: flexible benefits, health savings accounts
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InnovationsSeveral national unions and their employers have pioneered new strategies to protect employee benefits
In 2005, CAW and auto industry adopt Conditional Formulary: brand name drugs only funded with Special Authority by physician
In 2004-2006, CUPW and Canada Post initiate two pilot projects:
Health Canada funds use of herbal products to treat stress
Alternative Therapies for chronic back pain, stress
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Union MembersUnion members get information from broad array of sources, including patient advocacy groups
Often Pharma-funded and sponsored (CPGs, education)
Strong lobby for coverage of new drugs/devices
Media
Physicians
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Bargaining Climate
Employers reducing or holding the line on insurance premiums for health, drug and other benefits
Wage increases stagnant for last decade
Unionised workers are hitting a brick wall on wages and worried about push to reduce benefits, increase co-pays and deductibles
Employers (including government) negotiating Pharmacare formulary
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Going up: Drug costs & premiums; Wages: not so
much
2000
2002
2004
2006
2008
2010
0.002.004.006.008.00
10.0012.0014.0016.0018.00
Drug CostsHealth Insurance PremiumsAvg Annual Wage IncreasesCPI
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Cost Escalation 2011 Projected to 2019
(Mercer 2011)
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New Realities: Who’s Insured
Year All Male Female
Union
Non-Union
Full-time
Part-time
Under 25
% % % % % % % %
1995 63.3 68.6 47.6 84.3 49.2 NA NA 34.6
1999 52.9 58.9 47.3 67.4 47.7 595 19.8 23.8
2001 51.8 57.1 46.7 66.2 46.3 58.1 18.5 26.0
2005 51.3 56.2 46.7 61.6 47.5 57.2 19.3 21.7
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Who Is Insured, 2011
Province Percentage
Newfoundland 63.60
Prince Edward Island 40.50
Nova Scotia 35.00
New Brunswick 30.70
Quebec 63.00
Ontario 63.60
Manitoba 48.40
Saskatchewan 56.40
Alberta 45.80
British Columbia 36.10
CANADA 50.60
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Against this backdrop
Public sector employers in BC proposing Pharmacare formulary
Many rank and file members see it as a concession
Some unions supportive, others not
Main theme is uncertainty
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Defending certain principles…
Doctor-Patient Relationship
New is better
Choice
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1. Doctor-Patient Relationship
Both patient advocacy groups and unions believe the choice of drug is a matter between the doctor and patient
Public, including union members, believe that employers, unions and governments should not interfere with drug decisions
Few people understand what influences drug prescribing – or what should influence prescribing
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2. New vs OldPatient groups influence attitudes - want government to fund new drugs and devices
Unions want employer benefit plans to fund new drugs and devices
“Safe and effective” are two words strongly associated in the minds of most people with the newest (and most expensive) drugs
“Old” is associated with less safe and effective drugs
“Old” is pushed by Pharmacare and employers because they are cheap
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The importance of consumer choiceThe more drugs that are covered the more choices patients have
Safety and effectiveness are more important than cost
However, the real problem is not lack of choice, but lack of informed choice
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What Pharmacare should do
Public educationPharma is doing it, but governments aren’t
Support informed choiceRespect the ability of consumers to make the right decision when they have the information
Fund advocacyThere is very little independent patient advocacy and the main reason is lack of funding
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What unions should do
Find out what’s in the drug planNegotiate access to formulary, including cost and utilization data
Educate members about evidenced-based formularies
Evidence-based approach commonly conceived of as an approach to strengthening public drug benefits, but it may work in private plans, too
Members will support “evidence-based” managed formularies if they see a benefit for their families
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National Pharmacare
Strong support among Canadian unions and their members
Campaigns, education
Strong support among provinces
But no vigorous advocacy
Need to mobilise public!
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Thank-you!
Colleen Fuller
PharmaWatch Canada
Working for Consumer Rights and Safe Medicines
http://pharmawatchcanada.wordpress.com