1. Pharmacare Goes to the
Bargaining Table
PharmaCare 2020
February 26, 2013

2. Two important players
on the drug scene
Patient Advocacy Groups
Disease specific, campaign-oriented, fundraisers
Strong focus on public benefits, eg., Pharmacare
Unions
In BC, approximately 36% of employees are covered by
supplementary health benefits
Majority of these are union members
Unions are overlooked as key players

3. Shifting Sands
Two events that had a dramatic impact on bargaining
tables
Wage controls , 1975-78
Capped wage increases for 4.2 million workers at 10%; 8%
and 6%
Established Programs Financing, 1977
New law downloaded costs of medicare from federal to
provincial governments
Eroded federal leadership in health policy

4. 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

5. Innovations
Several 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

6. Union Members
Union 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

7. 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

8. Going up: Drug costs & premiums;
Wages: not so much
18.00
16.00
14.00 Drug Costs
12.00
10.00 Health Insurance
8.00 Premiums
6.00 Avg Annual Wage
4.00 Increases
2.00 CPI
0.00
2011
2000
2001
2004
2009
2010
2005
2002
2006
2003
2007
2008

9. Cost Escalation
2011 Projected to 2019
(Mercer 2011)

10. New Realities:
Who’s Insured
Non- Full- Part- Under
Year All Male Female Union
Union time time 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

11. 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

12. 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

13. Defending certain
principles…
Doctor-Patient Relationship
New is better
Choice

14. 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

15. 2. New vs Old
Patient 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

16. The importance of
consumer choice
The 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

17. What Pharmacare
should do
Public education
Pharma is doing it, but governments aren’t
Support informed choice
Respect the ability of consumers to make the right
decision when they have the information
Fund advocacy
There is very little independent patient advocacy and
the main reason is lack of funding

18. What unions should do
Find out what’s in the drug plan
Negotiate 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

19. National Pharmacare
Strong support among Canadian unions
and their members
Campaigns, education
Strong support among provinces
But no vigorous advocacy
Need to mobilise public!

20. Thank-you!
Colleen Fuller
PharmaWatch Canada
Working for Consumer Rights and Safe Medicines
http://pharmawatchcanada.wordpress.com