What’s on the Horizon for 2019?

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With the dawn of 2019 upon us, I pulled out four healthcare themes from the past year that I think will have a significant impact moving forward.

These four themes were partially chosen because they relate to an important Canadian policy change that could be on the near horizon.

Combination therapies

When looking at healthcare as a whole, many diseases are beginning to be managed with more than one treatment option at a time. The provision of two or more drugs that complement one another improve outcomes in a variety of diseases.

Personalized medicine

Certain genetic signatures can render a patient unlikely to respond to certain treatments, and more responsive to others. In addition, the genetic signature of some types of cancers can aid in predicting which therapies the cancer will respond to best.

Gene therapies

Genetic techniques as a treatment, or to aid in the development of treatments is expected to make the most pronounced gains. One such technology known as CAR-T has already made a significant splash in blood borne cancers, and will aim to launch an attack on solid tumours over the next few years.

Chronic disease management

Many patients now pass away with a disease, as opposed to from it. Take prostate cancer for example; 15 years ago it was the most commonly diagnosed cancer and also the leading cause of death in men. Now prostate cancer is the third most common cause of death while diagnosis rates have remained similar.

These four themes are highlighted in part because of the price tag associated with each of them. Combination therapies are expensive because more than one drug is being prescribed at a time. Personalized medicine and gene therapy both require the use of advanced genetic techniques and the cost associated with reagents, equipment, and personnel training on genetic techniques is considerable. Managing diseases in a chronic fashion is a terrific sign that the treatments are working, but it also means that a patient is being treated with a potentially expensive product for an extended period of time.

So why is the price tag of these themes important?

Short answer: A publicly funded prescription drug coverage plan, also known as national “pharmacare”, is on the horizon.

Currently Canada’s health care system covers visits to the doctor and medically necessary hospital care. However, when a patient goes to fill a prescription Canada, there is no universal coverage. In fact, Canada is the only country in the world that has universal healthcare, but not national pharmacare.

Over the past year Canadians spent $34 billion on prescription drugs. When compared to the other 33 OECD countries, Canada trails only the USA and Switzerland in prescription drug spending per capita. These high costs have led to millions of Canadians making appalling trade-offs to pay for their potentially life-saving medications.

Part of the reason we spend so much on prescription drugs is because our pharmacare plans are an assortment of approximately 100 public and over 100,000 private insurance plans. To address the shortcomings of the current siloed system, the Liberal government has been developing a national pharmacare plan over the past year.

Last February Eric Hoskins, a physician and the former Ontario Health Minister, was appointed Chair of the Advisory Council on the Implementation of National Pharmacare. Hoskins was the man behind the Ontario mini-pharmacare program whereby people under the age of 25 now have access to universal drug coverage.

Hoskins and his team have indicated that the blue print for a national pharmacare plan will be unveiled this spring. Once the blueprint is released it will likely take at least another year to implement, making pharmacare a red hot topic for election debates next October.

The cost of a publically funded pharmacare program has been predicted at $20 billion. However, some critics have balked at that number and suggested that the cost will be much higher. Last summer a former federal budget watchdog provided a sobering take on the subject when he stated that if Canadians want universal pharmacare, they should be prepared for an increase in taxes.

In addition to the affordability issue, if the Canadian government makes it too difficult for drug companies to make a profit in Canada, the whole concept of making sure citizens have access to drugs could backfire. The drug companies may simply refuse to launch their products here, or at least delay the launch if the profit margin is not apparent.

For what it’s worth, I think implementing nationalized pharmacare is a good idea despite the fiscal challenges and risk of backfiring. Canada is a first rate country and it should be held to the highest standards. It’s too many if even one citizen is denied access to a life-saving medication because of cost.

Healthy Living by Brennan Smith, PhD

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