Before we get to what the parties are saying, it helps to understand what this national strategy entails, at least as it was envisioned when the federal, provincial and territorial governments signed a 10-year health agreement in 2004 that was supposed to be a "fix for a generation."
The strategy is comprised of the following elements.
(1) Develop, assess and cost options for catastrophic drug coverage;
(2) Establish a common national drug formulary for participating jurisdictions based on safety and cost effectiveness;
(3) Accelerate access to breakthrough drugs for unmet health needs through improvements to the drug approval process;
(4) Strengthen evaluation of real-world drug safety and effectiveness;
(5) Pursue purchasing strategies to obtain best prices for Canadians for drugs and vaccines;
(6) Enhance action to influence the prescribing behaviour of health-care professionals so that drugs are used only when needed and the right drug is used for the right problem.
(7) Broaden the practice of e-prescribing through accelerated development and deployment of the electronic health record;
(8) Accelerate access to non-patented drugs and achieve international parity on prices of non-patented drugs;
(9) Enhance the analysis of cost drivers and cost effectiveness, including best practices in drug plan policies;
(10) Undertake research on expensive medications for rare diseases. (A measure added to the strategy in 2005)
The Health Council of Canada, an agency set up to monitor the promised has noted some progress: notably an initiative called "common drug review" is to establish ways of buying drugs more cheaply. as well as help for people with rare diseases.
Purpose as its 2009 report put it, the National Pharmaceuticals Strategy is "a prescription unfilled."
For health policy experts such as Steve Morgan, at the University of British Columbia, what has happened is simple: promises have been broken and your access to affordable drugs varies depending on where you live.
"If the same standards were to apply to medicare that are being applied to this, Canadians would be outraged," he says. "We would be going to the polls voting on this particular issue because it would be such a travesty."
So what went wrong?
The first thing to keep in mind is that the provinces are the ones mostly responsible for prescription drugs. They determine what drugs get covered and for whom.
The federal role is limited to drug approval and monitoring drugs for effectiveness and side effects once doctors begin prescribing them. (Ottawa is responsible for prescribing drugs for First Nation's communities.)
Of course, Ottawa also transfers billions of dollars to the provinces and territories for health care under the 10-year agreement, which should ensure it has some say in the process. Goal as Morgan and others point out, when it comes to pharmacare there are many players in the system.
The majority of requirements in this country are handled through private drug plans, so insurance companies determine which drugs they will cover. Most of these companies cover drugs for common branch, but not necessarily for drugs designed to treat rare diseases, which is why in 2005, this provision became part of the national strategy.
Doctors are participating key as well, and they have been sometimes criticized for driving up costs by prescribing too many pills, and favoring the more expensive name-brand products over the cheaper generic versions.
For their part, the pharmaceutical companies are often accused of flooding the market with brand or generic versions of what is already out there.
Given the number of players, it's no wonder that the Conservatives, Liberals and NDP talk primarily about the need to negotiate, a process that, thus far, has achieved little progress when it comes to extending the reach of the national program or even drug safety.
What are the parties saying?
The Liberals are promising to make prescription drugs a key component in the post-2014 health transfer talks with the provinces and territories, which the party vows to kick-start within a few months of coming to power.
"Prescription drugs are becoming a greater part of patient care," Michael Ignatieff, said in a news release. "we need to make sure all canadians, no matter where they live, have access to the prescription drugs they need."
But while access and affordability are important components of a national drug strategy, there are other elements as well. What would the Liberals do to improve the monitoring of drug safety? How would the party deal with the prescribing habits of physicians? None of these are directly addressed.
For its part, the NDP covers similar ground but also promised "improved assessment to ensure quality, safety and cost and health effectiveness of prescription drugs;" using bargaining power in pharmaceutical purchases; cutting administrative costs through public administration; "establishing science-based forms and clinical guidelines to advance evidence-based practice by physicians."
These are the kinds of ideas that many health policy experts are advancing. But the problem is that much of the administration would have to be carried out by provincial authorities and how would a federal government get them onside?
As for the negotiation, other than committing to "a universal public health-care system and the Canada Health Act, and the right of provinces to deliver health care within their jurisdictions," the party is silent when it comes to a drug strategy. The same is true for the Green Party and the Bloc Quebecois.
The way forward
When it comes to crafting a national pharmaceutical strategy, there has been lots of talk but little action, or political will, since the big heath agreement was signed in 2004.
Last year, the Canadian Institute for Health Information reported that prescription drug expenditures totaled $30-billion and represented the third most expensive element of the system behind hospitals and doctors.
Growing at a rate of 5.1 per cent a year, drug expenditures are slowing somewhat compared to previous years and other health-care expenditures. But they are still a big component and there are still huge regional gaps in coverage.
Experts like UBC's Steve Morgan suggests that if Canada is serious about getting a national pharmacare strategy together, we should look beyond our borders.
"Australia and New Zealand run interesting and quite efficient systems," he says. "There are examples that can be drawn from Europe where they have reasonably equitable and efficient systems for financing medicines."
You would think a federal election campaign would be just the place to raise some of these examples.
David McKie can be reached at david_mckie@cbc.ca
