Ontario elections: a missed chance for better Canadian healthcare

With Ontario’s Liberal Party having lost its efforts to clinch a fifth consecutive term, Canadian healthcare policy has in turn missed the chance for a much-needed overhaul. Kathleen Wynne, the recently-resigned premier, had promised to move forward a comprehensive pharmacare system if re-elected, starting with coverage for senior citizens and likely expanding to include other sections of the population.

Unfortunately, however, Wynne’s defeat means that the Liberals’ promises will not come to fruition. Of course, even had she won, Wynne would likely have faced significant resistance from lobbying groups about falling drug prices. On the other hand, her party’s ambitious proposals could have facilitated access to the notoriously impregnable Canadian market, which would have brought a windfall for manufacturers and consumers alike.

With it now clear that the Progressive Conservatives will take power, it’s difficult not to feel like Wynne’s loss is also Canada’s, with the nation having missed its chance to take a huge step forward in enacting truly universal healthcare.

Big spending budget from the Liberals

Having finally balanced the budget and gained a $600 million surplus after 15 years in power, the Liberal Party had announced an ambitious spending plan that would have seen them pledge a total of $20.3 billion over three years. The linchpin of their budget was massive healthcare reforms, including subsidies for caregivers, day care centers and drug and dental expenses.

The flagship policy, however, was free pharmaceuticals for over-65s from August 2019. The policy would have applied to over 4,400 eligible drugs and cost an estimated $575 million per year, and was expected to be just the tip of the iceberg in overhauling the pharmacare system. The Liberals also pledged to cover 80% of the cost of eligible drug and dental expenses for all citizens, up to a maximum of $700 per family of four.

Of course, though Wynne may have been defeated, perhaps all is not lost. At this point, it is still unclear whether the newly elected premier, Doug Ford, will roll back any of the reforms she enacted at the end of her mandate, including free pharmacare for under-25s. But given the fact that he campaigned on a platform of heavy tax cuts, it is unlikely that he’ll sign off on the high spending that more comprehensive pharmacare would demand.

A market crying out for reform

Yet reforms to the country’s pharma policy is long overdue. At present, achieving approval for new drugs and pharmaceuticals in Canada is a notoriously long and arduous process; although almost all new products in Canada have already been given the green light by regulatory bodies in the US and the EU, Health Canada insists on conducting its own tests. For instance, according to a study from the Fraser Institute, 30 of 31 new drugs tested in Canada in 2011 and 2012 had already been approved in the States and reached the American market a median of 386 days earlier than north of the border. Compared to Europe, all 31 drugs were approved and available to consumers a median of 267 days prior to Canada.

The authors of the study argue that Health Canada’s stubborn insistence on duplicate reviews of these drugs wastes time and costs lives. Their evidence certainly seems compelling. Had Canada simply accepted US or EU approvals in the period between 2005 and 2011-12, everyday Canadians would have had access to at least 152 new drugs a median of 494 days earlier than they actually did.

These figures might be difficult to contextualize, but the reality is that thousands of Canadians are suffering and dying as a result of these unnecessary delays. A report from Canadian Health Policy found that delayed access to 14 new cancer treatments between 2010-2013 could have negatively impacted 25,000 sufferers of the disease and cost the economy up to $823 million annually.

Rare diseases sufferers even more at risk

Even when a drug does receive approval, Canada’s healthcare system still allows sufferers of rare diseases to slip through the cracks. The high prices of such treatments mean that most everyday citizens cannot afford them and the government is reluctant to subsidize those for which it believes the costs outweigh the benefits.

For example, cystic fibrosis drug Orkambi could potentially help 50% of the 4,200 Canadians suffering from the disease, but provinces refuse to cover its cost, despite lobbying from pressure groups, politicians and individual sufferers. The government’s attitude is particularly frustrating given its inconsistency; last year, British Columbia granted access to the $750,000 drug Soliris for one sufferer of atypical hemolytic uremic syndrome. According to authorities, future applications for Soliris will be dealt with on a case-by-case basis – but with Orkambi, they won’t.

There are comparable issues surrounding the breakthrough drug Spinraza, which has shown positive results in slowing the effects of spinal muscular atrophy (SMA) in children and young adults. Spinraza was approved for coverage by the Canadian Agency for Drugs and Technologies in Health (CADTH) – but only for an incredibly small subset of sufferers of the often fatal disease. This has resulted in story after story after story of families unable to access the drug being forced to watch their child’s condition deteriorate as a result.

Future uncertain for Canadian healthcare

Of course, any (unlikely) attempts by the 42nd Parliament of Ontario to expand universal healthcare could well face opposition from the drug industry, which may be loath to see prices fall. Yet while healthcare reforms would certainly drive prices down, they would also entail an overhaul of the laborious process needed to gain access to the Canadian market – providing a much-needed boon to the industry in turn.

Improved access to the fragmented Canadian market – for both drug companies and patients – is exactly what the country needs, and this year’s election could have been the very catalyst to securing such a historic step forward. As things stand, it appears to be nothing more than a missed opportunity for these reforms.

This article does not necessarily reflect the opinions of the editors or management of EconoTimes.