National pharmacare, as run by omniscient angels

Marc-André Gagnon’s solution should be read by citizens of every political orientation

Marc-André Gagnon’s appeal for national pharmacare, published this past week by the Canadian Centre for Policy Alternatives, should be read by citizens of every political orientation. Yes, Prof. Gagnon has a simple, government-driven panacea for the ills of Canadian prescription-drug policy; but government is sometimes the cause of those ills, as his analysis is unprejudiced enough to show. I learned something especially horrifying about Quebec’s healthcare system from his paper [emphasis mine]:

In Quebec, prescription size was 37.4% smaller than the Canadian average. This is because the province’s public drug insurance program requires that prescriptions be renewed each month, unless the patient has special permission (for example, for a trip abroad). The Régie de l’assurance maladie du Québec [Quebec Health Insurance Plan] (RAMQ) requires that pharmacists fill orders of no more than a month, albeit repeats on prescriptions are allowed. Patients who have a chronic condition and take medication such as antihypertensives (for high blood pressure) or statins (for high cholesterol) on an ongoing basis must therefore have their prescriptions filled monthly, simply for administrative purposes. It would be easy to give these patients three- or six-month prescriptions, as is usually done in other provinces, without it affecting the quality of care. There are no studies in the medical literature showing any kind of therapeutic advantage to a monthly renewal of prescriptions for people with a chronic condition.

…The only reason for this state of affairs is that Quebec, as part of its Pharmacare program, wanted to make deductibles more “equitable” by establishing them on a monthly basis so that the costs would be spread more evenly over the year. Since deductibles are monthly, prescriptions must be monthly as well, increasing the number of prescriptions and associated fees. The workload for pharmacists is artificially increasing at a time when Quebec has a serious shortage of hospital pharmacists (Daoust-Boisvert 2009).

I take blood pressure medication, so if I ever move to Quebec I’ll be able to join the Pharmacare program and get my drugs for a modest upfront deductible—but at about sextuple the cost to that province in dispensing fees and paperwork, and sextuple the cost to myself in visits to the drugstore. (Imagine the carbon footprint!) If I were to value my own time realistically, the nuisance would cut deeply into the savings to me, and it might well represent an outright loss to many workers.

What equally infuriating inefficiencies could we expect a national pharmacare program designed by politicians to incorporate? Why, none at all; the only conditions are that Prof. Gagnon must design the program, the design must be adopted with absolutely no political modifications, he must be smart enough to have foreseen and prevented all possible hazards from Quebec-style perverse incentives and trough-wallowing, and he must rule the program forever with an iron fist and never retire, die, or grow inattentive. Given all of those assurances, I will be happy to endorse his scheme unreservedly.