Universal public coverage of 117 essential medicines could address the needs of most Canadians for pharmaceutical drugs, and possibly save more than $4 billion a year, according to a new study published http://www.cmaj.ca/site/press/cmaj.161082.pdf in CMAJ (Canadian Medical Association Journal).

“Adding an essential medicines list is a pragmatic step toward universal pharmacare,” states Steven Morgan, a professor in the School of Population and Public Health at the University of British Columbia (UBC). “It would ensure all Canadians have access to the most commonly required medicines while saving patients and private drug plan sponsors over $4 billion per year.”

The researchers identified a list of 117 essential medicines that accounted for 44% of all prescriptions filled at retail pharmacies in 2015 and up to 77% of all prescriptions when therapeutically similar medications were included. These medicines included antibiotics, insulin, heart medication, antidepressants, oral contraceptives and more.

“Universal pharmacare has been long-promised but undelivered in Canada, in part because of concerns about where to start,” said Morgan. “We show that adding universal public coverage of essential medicines to the existing system of drug coverage in Canada is a significant and feasible step in the right direction.”

In a related study published concurrently in CMAJ Open, researchers adapted the World Health Organization’s Model List of Essential Medicines, identifying 125 essential medications for Canada http://www.cmaj.ca/site/press/cmajo.20160122.pdf.

“The World Health Organization (WHO) says these essential medicines should be available to everyone who needs them,” said Dr. Nav Persaud, St. Michael’s Hospital, Toronto, who led the team that developed the essential medicines list and was a coauthor of the CMAJ paper. “We adapted the WHO’s list based on clinical practice in Canada.”

The authors of the CMAJ study note that it was a simulation study and thus based on assumptions around drug usage, prices, product substitutions and other factors.

Morgan and Persaud propose that governments purchase the essential medicines in bulk for all of Canada, which they found would save patients and private drug plans $4.3 billion per year while costing government an additional $1.2 billion per year.

“Commissions on the Canadian health care system have repeatedly concluded that universal, comprehensive public pharmacare is the most equitable and efficient means of achieving access to appropriate and affordable care for all Canadians,” the authors conclude.

Researchers from the University of British Columbia, Vancouver, BC, St. Michael’s Hospital and the University of Toronto, Toronto, Ontario, conducted the CMAJ study.


The CMAJ study was partially funded by a PSI Graham Farquharson Knowledge Translation Fellowship from the Physicians Services Incorporated Foundation, an IMPACT Award from the Ontario SPOR Support Unit and the Canadian Institutes of Health Research.