Pharmacare Goes to the Bargaining

TablePharmaCare 2020February 26, 2013

Two important players on the

drug scenePatient Advocacy GroupsDisease specific, campaign-oriented, fundraisers

Strong focus on public benefits, eg., Pharmacare

UnionsIn BC, approximately 36% of employees are covered by supplementary health benefits

Majority of these are union members

Unions are overlooked as key players

Shifting SandsTwo events that had a dramatic impact on bargaining tables

Wage controls , 1975-78Capped wage increases for 4.2 million workers at 10%; 8% and 6%

Established Programs Financing, 1977New law downloaded costs of medicare from federal to provincial governments

Eroded federal leadership in health policy

Bargaining Benefits

Since 2000, employers have exercised 3 main options to counter rising premiums:

Downloading (higher premiums & deductibles)Eliminating benefit plans (retirees hit hardest)Cost-shifting: flexible benefits, health savings accounts

InnovationsSeveral national unions and their employers have pioneered new strategies to protect employee benefits

In 2005, CAW and auto industry adopt Conditional Formulary: brand name drugs only funded with Special Authority by physician

In 2004-2006, CUPW and Canada Post initiate two pilot projects:

Health Canada funds use of herbal products to treat stress

Alternative Therapies for chronic back pain, stress

Union MembersUnion members get information from broad array of sources, including patient advocacy groups

Often Pharma-funded and sponsored (CPGs, education)

Strong lobby for coverage of new drugs/devices

Media

Physicians

Bargaining Climate

Employers reducing or holding the line on insurance premiums for health, drug and other benefits

Wage increases stagnant for last decade

Unionised workers are hitting a brick wall on wages and worried about push to reduce benefits, increase co-pays and deductibles

Employers (including government) negotiating Pharmacare formulary

Going up: Drug costs & premiums; Wages: not so

much

2000

2002

2004

2006

2008

2010

0.002.004.006.008.00

10.0012.0014.0016.0018.00

Drug CostsHealth Insurance PremiumsAvg Annual Wage IncreasesCPI

Cost Escalation 2011 Projected to 2019

(Mercer 2011)

New Realities: Who’s Insured

Year All Male Female

Union

Non-Union

Full-time

Part-time

Under 25

% % % % % % % %

1995 63.3 68.6 47.6 84.3 49.2 NA NA 34.6

1999 52.9 58.9 47.3 67.4 47.7 595 19.8 23.8

2001 51.8 57.1 46.7 66.2 46.3 58.1 18.5 26.0

2005 51.3 56.2 46.7 61.6 47.5 57.2 19.3 21.7

Who Is Insured, 2011

Province Percentage

Newfoundland 63.60

Prince Edward Island 40.50

Nova Scotia 35.00

New Brunswick 30.70

Quebec 63.00

Ontario 63.60

Manitoba 48.40

Saskatchewan 56.40

Alberta 45.80

British Columbia 36.10

CANADA 50.60

Against this backdrop

Public sector employers in BC proposing Pharmacare formulary

Many rank and file members see it as a concession

Some unions supportive, others not

Main theme is uncertainty

Defending certain principles…

Doctor-Patient Relationship

New is better

Choice

1. Doctor-Patient Relationship

Both patient advocacy groups and unions believe the choice of drug is a matter between the doctor and patient

Public, including union members, believe that employers, unions and governments should not interfere with drug decisions

Few people understand what influences drug prescribing – or what should influence prescribing

2. New vs OldPatient groups influence attitudes - want government to fund new drugs and devices

Unions want employer benefit plans to fund new drugs and devices

“Safe and effective” are two words strongly associated in the minds of most people with the newest (and most expensive) drugs

“Old” is associated with less safe and effective drugs

“Old” is pushed by Pharmacare and employers because they are cheap

The importance of consumer choiceThe more drugs that are covered the more choices patients have

Safety and effectiveness are more important than cost

However, the real problem is not lack of choice, but lack of informed choice

What Pharmacare should do

Public educationPharma is doing it, but governments aren’t

Support informed choiceRespect the ability of consumers to make the right decision when they have the information

Fund advocacyThere is very little independent patient advocacy and the main reason is lack of funding

What unions should do

Find out what’s in the drug planNegotiate access to formulary, including cost and utilization data

Educate members about evidenced-based formularies

Evidence-based approach commonly conceived of as an approach to strengthening public drug benefits, but it may work in private plans, too

Members will support “evidence-based” managed formularies if they see a benefit for their families

National Pharmacare

Strong support among Canadian unions and their members

Campaigns, education

Strong support among provinces

But no vigorous advocacy

Need to mobilise public!

Thank-you!

Colleen Fuller

PharmaWatch Canada

Working for Consumer Rights and Safe Medicines

http://pharmawatchcanada.wordpress.com