When thinking about mental health care, one would expect medication coverage to be included. While mental health and pharmacare are parts of universal health care for many countries, Canada lags behind as the exception.
Currently, pharmacare coverage only includes medically necessary medications given in hospitals and physician services. In Ontario for instance, those below 24 years and over 65 years may qualify for the Ontario Drug Benefit program, however this program only covers a select number of medications. Unfortunately, there is no coverage for community-based, non-physician mental health services or prescription medication for mental health therapies.
According to the Advisory Council on Implementation of National Pharmacare 1 in 5 Canadians struggle to pay for medications and either do not have prescription drug insurance or the plan they have is inadequate to cover their medical needs. According to Statistics Canada, 2.3 million Canadians do not have their mental health care needs adequately met. The limited access to medications does not help save money, either. In actuality, the pharmaceuticals industry plays a big role in our economy with medications being the second biggest expenditure in the Canadian healthcare system after hospitals.
The current mix of private and public drug programs leaves us with a fragmented system that creates accessibility gaps and high costs of medication, putting many Canadians' health and well-being at risk. In addition, each province governs its pharmaceutical system, leading to disparities in the system. This has also led to disparities in mental health services across Canada.
The financial barriers Canadians face to accessing pharmaceuticals is an important factor to the under-use of mental health treatments. Even those with private insurance lack access to some mental health medications, with only 19.3% of individuals actually receiving treatment.
Canada is the only country with a “universal” healthcare system that does not include pharmacare. Countries such as Germany and the United Kingdom offer universal drug coverage that includes access to psychiatric medication. The United Kingdom, for example, provides free prescriptions in Scotland and Wales. While England requires some prescription charges, however, the majority of prescribed medications are offered free of charge, or come with the option to purchase a prescription prepayment certificate.
Where do we go from here?
Building a universal public drug coverage program has been attempted throughout Canada’s history of medicare, but it has been a continued political struggle. Opponents of universal pharmacare believe the current system works well for most Canadians, and we should just fill the gaps in coverage without building a real alternative to the for-profit system. However, this is far from true. We have seen in the United States that the fragmented system of filling in the gaps actually widens the accessibility gap of resources. Without pharmacare, we cannot truly make progress in treating mental health illnesses. The Broadbent Institute report Pharmacare Now outlines two pathways for Canada to achieve a national Pharamcare program.
One option is to have a Federal-Provincial-Territorial program, which has the federal government set standards similar to the Canada Health Act while providing some transfer funding. Under this option, the funding would be provided under two kinds of schemes: universal coverage for essential drugs with no co-payments or deductible; or have an arms-length body identify a list of essential drugs and negotiate with drug companies on prices.
The second option to consider is a federally funded agency in charge of financing, regulating, and administering coverage programs. This approach was successfully used to establish Canadian Blood Services and was able to achieve cost savings.
Solving the inequality in medicine is not something that can be solved by one policy change. Still, if we want mental health to truly be a part of our healthcare system, we need pharmacare to treat these health issues. A major shift is needed towards a universal pharmacare plan. It is not a matter of if we can do it, but a matter of when our government will take action and make the change.
Amal Abdulrahman is a fellow of the Diversity Youth Fellowship hosted by the Urban Alliance on Race Relations, and graduate student in International Health at Johns Hopkins Bloomberg School of Public Health.
Header photo by Laurynas Mereckas on Unsplash.