1. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH Post-Romanow Pharmacare: Reflections on the Shifting Landscape Steve Morgan, PhD Centre for Health Services and Policy Research University of British Columbia

2. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The coverage landscape: Under- and Un-insured for Routine Drug Costs Source: Applied Management (2000) "Canadians’ Access to Insurance for Prescription Medicines Volume 2”

3. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The coverage landscape continued: Under- and Un-insured for Catastrophic Costs Source: Applied Management (2000) "Canadians’ Access to Insurance for Prescription Medicines Volume 2”

4. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The financial landscape Source: CIHI and Statistics Canada

5. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH What did Romanow recommend? Universal “mixed” pharmacare –Catastrophic coverage for all Canadians –First-dollar coverage for vulnerable –Disease management Agency/network for –Drug regulation –Drug policy –Outcomes and policy research

6. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH What are policy makers seeing?

7. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The Shifting Landscape?

8. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The financial landscape Source: CIHI and Statistics Canada

9. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH The demographic landscape Source: Statistics Canada

10. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH What are policy makers doing?

11. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH Drug cost control Common Drug Review –Standards of evidence? –Level of impact? Reference drug pricing –BC’s = RDP –MB & SK = MAC Terms of coverage …

12. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH Health Services Minister Colin Hansen, 24 February 2003

13. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH Pros/Cons of income-based plans Politically –Fairness resonates / Seniors backlash Access to medicines –Non-senior benefits / Incentive effects Equity –Non-seniors gain / Chronically ill may lose Efficiency –“Holding the tail of the elephant”

14. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH What next? … Need agency / network of agencies –Quebec leading example?? Post-marketing outcomes research –Requires data & expertise BC leading example?? Evidence-based policy –Requires political commitment & research BC leading example??

15. Centre for H EALTH S ERVICES AND P OLICY R ESEARCH Thank you