Fragmented Drug Coverage in a Universal Healthcare System
Canada, renowned for its universal healthcare system, faces significant disparities in prescription drug access, according to a new study published in the Canadian Journal of Cardiology. The research examined provincial and territorial variations in public pharmacare programs for cardiovascular drugs, revealing widespread inequities and gaps in access to essential medications. Despite Canada’s reputation for low drug prices and equitable healthcare, the study underscores the challenges posed by its fragmented drug review and reimbursement processes.
The analysis focused on medications for heart failure with reduced ejection fraction and antiplatelet therapies for acute coronary syndromes—two prevalent cardiovascular conditions. Findings showed that only a third of Canadians are eligible for publicly funded drug plans, with coverage decisions often misaligned with Canadian Cardiovascular Society (CCS) guidelines. Co-lead investigator Dr. Morgane Laverdure from the University of Ottawa Heart Institute noted, “Our study showed that CADTH (Canadian Agency for Drugs and Technology in Health) recommendations were followed only 33% of the time, and nearly a quarter of decisions were discordant with Canadian guidelines.”
Key Findings Highlight Gaps in Equity and Evidence-Based Care
The study identified systemic deficiencies in drug formulary updates and reimbursement processes. Among the findings:
- Significant interprovincial variation exists in drug reimbursement approvals despite a shared Health Technology Assessment process in all provinces except Quebec.
- No protocols are in place for timely updates to formularies to incorporate new evidence, pricing changes, or advances in Cardiovascular drugs.
- Formularies showed 23% discordance with guideline-based recommendations, with novel drugs being particularly affected.
An editorial accompanying the study criticized the fragmented nature of drug coverage in Canada. Dr. Jafna Cox from Dalhousie University highlighted that while Canadians have equitable access to physician and hospital services under the Canada Health Act, prescription drug access varies widely. He stated, “Wherever we live in Canada, we pay similar taxes expecting comparable healthcare. However, access to basic, guideline-directed treatment is often restricted, particularly for older and lower-income patients reliant on public drug plans.”
Calls for Reform and Future Implications
The researchers emphasized the need for a unified, evidence-based framework to address inequities in Cardiovascular drug access. Co-lead investigator Dr. Derek Y.F. So urged the adoption of a simplified and consistent system that allows equal access to medications across provinces. He remarked, “The current system leads to significant inequities, with Canadians in different provinces having varied access to evidence-based treatments. A consistent process with timely formulary updates can better address the health needs of Canadians, especially vulnerable populations.”
The study also noted that Canada is not alone in facing these challenges, as other countries with decentralized healthcare systems, such as Sweden and Norway, grapple with similar issues. Dr. Laverdure added, “Our findings and potential solutions can be of interest to other international jurisdictions facing fragmented pharmacare systems.”
As Canada explores solutions like universal pharmacare, the study’s findings highlight the urgent need for systematic reform to ensure equitable and evidence-based drug access for all Canadians.
