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While implementing a national pharmacare program is a worthy goal, some important barriers to its long term success need to be addressed. Like many developed nations, Canada is seeing a rapid growth in its senior population. One in five Canadians presently are 65 and older and in the next 20 years it is projected to increase to one in four.[1] Although the elderly currently represent a small proportion of the Canadian population, they consume approximately 40% of prescription drugs.[2] Remarkably, as many as one in four seniors in Canada are prescribed 10 or more unique drug classes.[3] In turn, usage of multiple drugs increases the risk of adverse events leading to emergency department visits or hospitalization. Thus, greater drug coverage does not always translate into improved health.
Another major challenge is the coverage of drugs for rare diseases. Regulatory approvals for these drugs have increased dramatically in recent years and these drugs are notable for their extraordinary price tags. In a 2022 analysis, public spending on these drugs in 2010 was estimated at $14.8 million in Canada; however, they projected growth to $1.6 billion by 2025.[4] Currently, only around 5% of rare diseases have US FDA approved drugs,[5] but the race is on to develop drugs for many of the remaining conditions. This highlights how current drug costs for rare diseases represent only a small fraction of future projections.
In conclusion, while nobody would deny the inefficiency of the current patchwork system of Canadian drug coverage, sustainability of a national coverage program needs to take a hard look at the barriers that lay ahead.
References
1. Ferriera J. This is what Canada will look like in 20 years – are we ready for an aging population? CTV News 12 Dec 2023. https://www.ctvnews.ca/canada/this-is-what-canada-will-look-like-in-20-y.... Accessed 28 Apr 2024.
2. Canadian Institute for Health Information. Drug Use Among Seniors in Canada, 2106. https://secure.cihi.ca/free_products/drug-use-among-seniors-2016-en-web.pdf. Accessed 28 Apr 2024.
3. Canadian Institute for Health Information. Changes in drug prescribing to seniors in Canada. 2022. https://www.cihi.ca/en/changes-in-drug-prescribing-to-seniors-in-canada. Accessed 28 Apr 2024.
4. Lech R, Chow G, Mann K, Mott P, Malmberg C, Forte L. Historical and projected public spending on drugs for rare diseases in Canada between 2010 and 2025. Orphanet J Rare Dis 2022;17:371. doi:10.1186/s13023-022-02534-z
5. LJ, Miller KL. A comprehensive study of the rare diseases and conditions targeted by orphan drug designations and approvals over the forty years of the Orphan Drug Act. Orphanet J Rare Dis 2023;18:163. doi:10.1186/s13023-023-02790-7
Competing interests:
No competing interests
01 May 2024
Ernest Hoptioncann
Student
Faculty of Health Sciences
Simon Fraser University, 8888 University Dr W, Burnaby, BC, Canada
Critical Barriers to National Pharmacare
Dear Editor,
While implementing a national pharmacare program is a worthy goal, some important barriers to its long term success need to be addressed. Like many developed nations, Canada is seeing a rapid growth in its senior population. One in five Canadians presently are 65 and older and in the next 20 years it is projected to increase to one in four.[1] Although the elderly currently represent a small proportion of the Canadian population, they consume approximately 40% of prescription drugs.[2] Remarkably, as many as one in four seniors in Canada are prescribed 10 or more unique drug classes.[3] In turn, usage of multiple drugs increases the risk of adverse events leading to emergency department visits or hospitalization. Thus, greater drug coverage does not always translate into improved health.
Another major challenge is the coverage of drugs for rare diseases. Regulatory approvals for these drugs have increased dramatically in recent years and these drugs are notable for their extraordinary price tags. In a 2022 analysis, public spending on these drugs in 2010 was estimated at $14.8 million in Canada; however, they projected growth to $1.6 billion by 2025.[4] Currently, only around 5% of rare diseases have US FDA approved drugs,[5] but the race is on to develop drugs for many of the remaining conditions. This highlights how current drug costs for rare diseases represent only a small fraction of future projections.
In conclusion, while nobody would deny the inefficiency of the current patchwork system of Canadian drug coverage, sustainability of a national coverage program needs to take a hard look at the barriers that lay ahead.
References
1. Ferriera J. This is what Canada will look like in 20 years – are we ready for an aging population? CTV News 12 Dec 2023. https://www.ctvnews.ca/canada/this-is-what-canada-will-look-like-in-20-y.... Accessed 28 Apr 2024.
2. Canadian Institute for Health Information. Drug Use Among Seniors in Canada, 2106. https://secure.cihi.ca/free_products/drug-use-among-seniors-2016-en-web.pdf. Accessed 28 Apr 2024.
3. Canadian Institute for Health Information. Changes in drug prescribing to seniors in Canada. 2022. https://www.cihi.ca/en/changes-in-drug-prescribing-to-seniors-in-canada. Accessed 28 Apr 2024.
4. Lech R, Chow G, Mann K, Mott P, Malmberg C, Forte L. Historical and projected public spending on drugs for rare diseases in Canada between 2010 and 2025. Orphanet J Rare Dis 2022;17:371. doi:10.1186/s13023-022-02534-z
5. LJ, Miller KL. A comprehensive study of the rare diseases and conditions targeted by orphan drug designations and approvals over the forty years of the Orphan Drug Act. Orphanet J Rare Dis 2023;18:163. doi:10.1186/s13023-023-02790-7
Competing interests: No competing interests