Governments should pay for essential prescribed medicines for all Canadians, thus improving their health care, new research suggests.

“Essential medicine lists” name drugs that are needed by health-care systems and should be available at all times to everyone who needs them. Examples include insulin, some antibiotics and oral contraceptives.

The World Health Organization introduced the concept, and more than 110 countries have adapted it to their needs. Canada hasn’t, despite a 2012 call from the House of Commons health committee to establish such a list as soon as possible.

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In Monday’s issue of the CMAJ Open, an online open-access journal, Dr. Nav Persaud, a family physician at St. Michael’s Hospital in Toronto, and his team describe how they developed a preliminary Canadian essential medicines list of 125 drugs.

“If you look at the medications on the list, these are treatments for high blood pressure, diabetes, HIV,” Persaud said in an interview. The medications have been shown to save lives.

“We also know that there are people who don’t take these medications because of the cost. If you put those two things together, it seems likely that an essential medicines list could improve care and improve life expectancy.”

Skipped pills

It’s estimated that in Canada, one in 10 people or about 3 million, cannot afford prescribed medications.

“I care for people who have come from lower-income countries where they have medication access programs and then they’ve been surprised when they came here and didn’t have access to medications,” Persaud said. 

Persaud said he now prescribes from the shortened list of medicines because it’s easy to remember doses and interactions.

In a related study published in the same issue, researchers propose that governments buy essential medicines in bulk for all of Canada.

Steven Morgan, a professor in the School of Population and Public Health at the University of British Columbia, and his team said adding an essential medicine list would ensure all Canadians have access to the most commonly needed medicines.

Morgan’s team estimated savings from universal public coverage of essential medicines of $4.27 billion per year for patients and private drug plan sponsors, at an incremental government cost of $1.23 billion per year. 

“Doing so may be a pragmatic step forward while more comprehensive pharmacare reforms are planned,” Morgan and his co-authors concluded.

‘Overpaying is out of control’

More than one in five Canadians report they or someone in their household has skipped doses, split pills or not filled prescriptions to save money on medication in the previous year.

Amir Attaran, a professor in the law and medicine faculties at the University of Ottawa who has studied generic drug pricing, believes universal, public coverage of essential medicines is possible and desirable. He was not involved in the CMAJ Open research.

“Our price problem in Canada is not with the patented medicines so much as the off-patent, generic ones,” Attaran said. “That’s where our overpaying is out of control.”

Attaran believes provinces, territories and the federal government could negotiate better deals for generic drugs. 

Prime Minister Justin Trudeau’s mandate letter to Health Minister Jane Philpott included a commitment to “improve access to necessary prescription medications.”