In December 2001, details leaked out of the Campbell governments deep cuts to the provincial prescription drug program. The gutting of Pharmacare increases prescription user fees for seniors and raises the deductible for working families, leaving nearly all British Columbians paying more for prescription drugs.
Low-income seniors will pay $10 per prescription (instead of paying the pharmacy dispensing fee) up to an unchanged yearly limit of $200. Other seniors will pay $25 a prescription and their maximum will increase by $75 to $275. The deductible for most people under 65 and their families will rise from $800 to $1,000. Low-income individuals and families will see their ceiling rise from $600 to $800.
The cost hikes erase what benefit if any many low and middle-income households would have seen from the Campbell governments problematic tax cuts, and add to the tally of programs being attacked to pay for those cuts. Meanwhile the top 10 per cent of earners will still reap tax cut rewards, as progressive income taxes are replaced with regressive taxes, including a hike in health premiums.
Community response was swift, and came from all quarters showing the wide range of BC residents who count on this successful public program. “For people living with HIV and AIDS, prescription drugs are literally a matter of life and death,” says Glen Hillson, chair of the BC Persons with AIDS Society.
He says people living with HIV and AIDS count on prescription drugs to prolong their lives and improve their health by slowing the diseases progress and fighting infections and other side effects. A high proportion of people living with HIV and AIDS are low-income. Any increase in user fees or point of purchase fees, or cuts in coverage, therell be a huge impact, he says.
The government isnt addressing rising drug costs. Theyre simply transferring costs onto individuals, says Lorna Gunn, director of the Council of Senior Citizens Organizations of BC (COSCO). That will force people to make impossible choices between prescription drugs and food or shelter. A single senior on the Guaranteed Income Supplement is getting under $1,000 a month. They dont have room in their budgets for new expenses.
At the same time, the Campbell government has ended coverage of physiotherapy, podiatry, naturopathy, chiropractic and massage therapy for many. Low-income people will only get severely limited coverage, making a holistic approach to health a privilege for the wealthy despite the benefits of cost-effective preventative medicine.
Studies show the Pharmacare cuts will not only shift costs onto individuals who can ill afford to pay, they will increase overall health care costs.
If moderate and low-income people pay for drugs out of pocket, they may simply go without. That could end up costing the health care system far more than any Pharmacare costs, as people end up in emergency rooms and are hospitalized.
If you dont support people in staying healthy, theyre going to end up in much more expensive care much sooner, says Hillson.
When Quebec introduced a user fee, prescription use dropped and visits to doctors and emergency rooms increased dramatically. Its that simple a relationship, says Gunn. A study in the Journal of the American Medical Association confirms the consequences for seniors and people on social assistance.
The government is also threatening to introduce means tests for seniors and people with disabilities, forcing them to prove theyre poor enough for coverage. A leaked budget document suggests 400,000 seniors about 78 per cent of BC seniors will pay $395 million more. According to CCPA researcher Sylvia Fuller, To exclude more than three quarters of seniors from full coverage means that the means testing bar is going to have to be set punishingly low. Fully two thirds of seniors have taxable incomes below $25,000. Administering such sweeping tests to find a small number of seniors will cost far more than it will save.
The cuts have already had a devastating impact on seniors. In April, a London Drugs pharmacy manager told the Vancouver Sun that BC seniors had bought 38 per cent fewer prescriptions since the cuts. The manager estimates 700,000 prescriptions went unfilled in the first three months of 2002.
Agenda for change
COSCO and other groups supporting public Pharmacare have a clear agenda for improving the public program without cutting coverage. They point to 20-year drug patent protection as a key cost culprit, along with over-prescribing and direct-to-consumer and doctor-targeted advertising, which is creeping into Canada. There are clear public solutions in each case, including stronger provincial and federal regulation and oversight.
One important component of any solution is the expansion of the provinces reference-based pricing system. The policy controls drug costs by requiring the use of generic or low-cost drugs that have been proven as clinically effective as patented equivalents, but doesnt yet apply to all drugs. The Campbell government has targeted this program for review, despite admitting it saves money.
One of COSCOs suggestions is to look beyond drug-based treatment. If you have someone with mild hypertension, instead of automatically putting someone on medication, try a preventative approach through exercise and diet first, says Gunn.
Gunn says these and other suggestions are being shunted aside in favour of demonizing Pharmacare without looking at causes or benefits. They just keep repeating over and over again that it costs too much. Well for us, thats not a convincing case for anything.
In fact, the provinces Pharmacare program is a model for other provinces. The province actually spends less per capita on drugs (public and private combined) than any other province, according to data from the Canadian Institute of Health Information. One of the reasons for the low costs is the high percentage of drug expenditures that are publicly paid, in a form of bulk purchasing.
BC has managed to keep yearly per capita costs at a cross-Canada low despite having the highest percentage of residents over age 65. BC also spends less of its total health care budget on drugs than any other province.
Pharmacares more than sustainable right now. To say otherwise is a lie. We need to be working to increase that access not cut people off, says Hillson.